Provider Demographics
NPI:1144901414
Name:CASTLEBERRY, IMANI MONIQUE
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:MONIQUE
Last Name:CASTLEBERRY
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 1:1731 BUNKER HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3026
Mailing Address - Country:US
Mailing Address - Phone:202-538-9640
Mailing Address - Fax:
Practice Address - Street 1:9306 LOUGHRAN RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6813
Practice Address - Country:US
Practice Address - Phone:301-399-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00170517376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide