Provider Demographics
NPI:1245052083
Name:WICHOWSKI, ZAKIA TANISHA (DOULA)
Entity type:Individual
Prefix:
First Name:ZAKIA
Middle Name:TANISHA
Last Name:WICHOWSKI
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10422 RUNNING CEDAR LN APT 304
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBRG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8253
Mailing Address - Country:US
Mailing Address - Phone:703-919-2257
Mailing Address - Fax:
Practice Address - Street 1:10422 RUNNING CEDAR LN APT 304
Practice Address - Street 2:
Practice Address - City:FREDERICKSBRG
Practice Address - State:VA
Practice Address - Zip Code:22407-8253
Practice Address - Country:US
Practice Address - Phone:703-919-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator