Healthcare Provider Details

I. General information

NPI: 1982955068
Provider Name (Legal Business Name): PRINCHELLE DELORES WHITEHEAD HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 4TH ST SE APT 12
WASHINGTON DC
20032-3350
US

IV. Provider business mailing address

4331 4TH ST SE APT 12
WASHINGTON DC
20032-3350
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0935
  • Fax: 202-545-0176
Mailing address:
  • Phone: 202-545-0935
  • Fax: 202-545-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: