Provider Demographics
NPI:1902302706
Name:GWALTNEY, ANNETTA
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 CORNING AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3063
Mailing Address - Country:US
Mailing Address - Phone:202-629-8619
Mailing Address - Fax:
Practice Address - Street 1:2424 CORNING AVE APT 202
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-3063
Practice Address - Country:US
Practice Address - Phone:202-629-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant