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General NPI Number Information
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NPI Number | 1538581483
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Entity Type | Organization
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Legal Business Name | TRINITY WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 1615 RHODE ISLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-1802
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Country | US
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Telephone | 571-275-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 RHODE ISLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-1802
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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 | FAMILY NURSE PRACTITIONER
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Name | RUBY ANUMAH
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Credential |
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Telephone | 571-275-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | RN1031207
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License Number State | DC
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