Provider Demographics
NPI:1144726589
Name:WASHINGTON, MICHELLE LISANN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LISANN
Last Name:WASHINGTON
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 1:2405 VIDALIA CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3781
Mailing Address - Country:US
Mailing Address - Phone:202-290-6821
Mailing Address - Fax:
Practice Address - Street 1:1403 MONTANA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3412
Practice Address - Country:US
Practice Address - Phone:202-629-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70171308Medicaid