=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003958208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILAJURINE TYWANKA LINDSAY P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 05/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 PENNSYLVANIA AVE SE SUITE 50
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20003-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-787-5702
-----------------------------------------------------
Fax | 202-787-5700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 PENNSYLVANIA AVE SE SUITE 50
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20003-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-787-5702
-----------------------------------------------------
Fax | 202-787-5700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA30191
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 7664
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------