Provider Demographics
NPI:1144934860
Name:ANTWI, DORA
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:ANTWI
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 1:2690 PENBURY CT APT 302
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4238
Mailing Address - Country:US
Mailing Address - Phone:571-866-0105
Mailing Address - Fax:
Practice Address - Street 1:2046 RICHMOND HWY STE A
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7276
Practice Address - Country:US
Practice Address - Phone:202-604-1610
Practice Address - Fax:808-466-1211
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA921600969Medicaid