Healthcare Provider Details

I. General information

NPI: 1194308981
Provider Name (Legal Business Name): MISS JOY ELOHO OKOLAGBODI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 KNOX TER SE
WASHINGTON DC
20020-1834
US

IV. Provider business mailing address

2727 KNOX TER SE
WASHINGTON DC
20020-1834
US

V. Phone/Fax

Practice location:
  • Phone: 240-620-8278
  • Fax:
Mailing address:
  • Phone: 240-620-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00193168
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: