Healthcare Provider Details

I. General information

NPI: 1821841172
Provider Name (Legal Business Name): JULIET EGWIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12308 JUSTICE PL
GLENN DALE MD
20769-9176
US

IV. Provider business mailing address

12308 JUSTICE PL
GLENN DALE MD
20769-9176
US

V. Phone/Fax

Practice location:
  • Phone: 202-286-2143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1003394
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: