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General NPI Number Information
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NPI Number | 1770842379
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Entity Type | Individual
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Provider Name | ERNEST N ETAHKWELLE
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 3001 BLADENSBURG RD NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2235
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Country | US
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Telephone | 202-635-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 7006 GOOD LUCK RD
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City | LANHAM
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State | MD
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Zip | 20706-3709
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Country | US
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Telephone | 240-413-3437
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 2966135
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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