Provider Demographics
NPI:1730701772
Name:DANCE, IVORY LAKEIA
Entity type:Individual
Prefix:
First Name:IVORY
Middle Name:LAKEIA
Last Name:DANCE
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 1:9722 MEMPHIS PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3865
Mailing Address - Country:US
Mailing Address - Phone:240-230-2129
Mailing Address - Fax:
Practice Address - Street 1:2908 16TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1822
Practice Address - Country:US
Practice Address - Phone:202-269-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant