Provider Demographics
NPI:1104699958
Name:HAYWARD, ANGELIC EBONEE
Entity type:Individual
Prefix:
First Name:ANGELIC
Middle Name:EBONEE
Last Name:HAYWARD
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 1:1518 FORT DAVIS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6026
Mailing Address - Country:US
Mailing Address - Phone:240-761-3114
Mailing Address - Fax:
Practice Address - Street 1:1518 FORT DAVIS ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6026
Practice Address - Country:US
Practice Address - Phone:240-761-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant