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General NPI Number Information
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NPI Number | 1114537305
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Entity Type | Individual
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Provider Name | MS. EVANGELINE CHINWE GAINES
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 85 S BRAGG ST # 401
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2797
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Country | US
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Telephone | 703-814-5106
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 E CAPITOL ST NE
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City | WASHINGTON
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State | DC
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Zip | 20003-1507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN1008922
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License Number State | DC
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