Healthcare Provider Details

I. General information

NPI: 1578384947
Provider Name (Legal Business Name): LANITA ANDRIA SPEARS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 Q ST NE APT 1327
WASHINGTON DC
20002-2381
US

IV. Provider business mailing address

600 PA AVE SE STE 210
WASHINGTON DC
20003-4344
US

V. Phone/Fax

Practice location:
  • Phone: 202-910-0277
  • Fax:
Mailing address:
  • Phone: 202-282-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number376K00000X
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: