Kenneth Chucks Egbufoama

Individual provider Active NPI Nurse's Aide · Washington, DC

NPI 1265021885 · NPPES record last updated Jan 18, 2021

Key facts

NPI
1265021885
Entity type
Individual (NPI type 1)
Primary specialty
Nurse's Aide 376K00000X
License
NA0000812544 (WA)
Practice address
6323 Georgia Ave NW Ste 305
Washington, DC 20011-1141
Phone
(202) 506-1242
Fax
(202) 506-1396
NPI assigned
Jan 18, 2021
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
NA0000812544WAMDNurse's Aide

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X NA0000812544 WA Yes

Addresses

Primary practice location

6323 Georgia Ave NW Ste 305
Washington, DC 20011-1141

Mailing address

6323 Georgia Ave NW Ste 305
Washington, DC 20011-1141
Phone (202) 506-1242

Other providers in Washington, DC

All providers in Washington, DC · Nurse's Aide in District of Columbia

Sources for this page

Verify at the official NPI Registry.