Provider Demographics
NPI:1003466244
Name:DOUGLAS, ESTHER ENID
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:ENID
Last Name:DOUGLAS
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 1:1220 12TH ST SE STE G35
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3738
Mailing Address - Country:US
Mailing Address - Phone:202-544-8090
Mailing Address - Fax:202-544-8091
Practice Address - Street 1:2010 PAULETTE RD APT 204
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5861
Practice Address - Country:US
Practice Address - Phone:202-840-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14603374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide