Healthcare Provider Details

I. General information

NPI: 1972000115
Provider Name (Legal Business Name): CHRISTIANA N ESOTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE G35
WASHINGTON DC
20003-3738
US

IV. Provider business mailing address

9873 GOOD LUCK RD APT 9
LANHAM MD
20706-3230
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8090
  • Fax: 202-544-8091
Mailing address:
  • Phone: 301-765-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13568
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: