| |
1160 Varnum St Ne Ste 218 Washington DC 20017-2106 | |
(202) 269-6600 | |
(202) 621-9564 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1160 Varnum St Ne Ste 218, Washington, District Of Columbia |
Authorized Official Name and Position | Deborah Okonofua (CEO) |
Authorized Official Contact | 2022696600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1160 Varnum St Ne Ste 218 Washington DC 20017-2106 Ph: (202) 269-6600 | 1160 Varnum St Ne Ste 218 Washington DC 20017-2106 Ph: (202) 269-6600 |
NPI Number | 1316518574 |
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Provider Enumeration Date | 07/08/2021 |
Last Update Date | 04/23/2024 |
Medicare PECOS PAC ID | 5496195257 |
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Medicare Enrollment ID | O20240428000052 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316518574 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Deborah E Okonofua |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023345873 PECOS PAC ID: 3274728696 Enrollment ID: I20101111000513 |
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