Healthcare Provider Details

I. General information

NPI: 1093629255
Provider Name (Legal Business Name): NIDJA MICHELLE WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER, NAVAL MEDICAL CENTER 100 BREWSTER BLVD
CAMP LEJEUNE NC
28547
US

IV. Provider business mailing address

COMMANDING OFFICER, NAVAL MEDICAL CENTER 100 BREWSTER BLVD
CAMP LEJEUNE NC
28547
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-2208
  • Fax:
Mailing address:
  • Phone: 910-451-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH36033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: