Healthcare Provider Details

I. General information

NPI: 1457216574
Provider Name (Legal Business Name): MS. NIAYA IMANI-ADA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 POTOMAC AVE APT 308
ARLINGTON VA
22202-4572
US

IV. Provider business mailing address

3404 SOAPSTONE CT
WALDORF MD
20601-4637
US

V. Phone/Fax

Practice location:
  • Phone: 301-885-8231
  • Fax:
Mailing address:
  • Phone: 301-885-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500007356
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: