=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326825183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVON DEMETRE STURGIS FIRST AID
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2023
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 2ND PL SE APT 702
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20003-2563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-590-5944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 7TH ST SW APT 512A701
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20024-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-779-5982
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 432661
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------