Provider Demographics
NPI:1063023893
Name:RWA INNOVATIVE PROVIDERS LLC
Entity Type:Organization
Organization Name:RWA INNOVATIVE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUKAYAT
Authorized Official - Middle Name:OLUWADAMILOLA
Authorized Official - Last Name:BOJUWON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:202-494-2582
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-1706
Mailing Address - Country:US
Mailing Address - Phone:202-408-7609
Mailing Address - Fax:
Practice Address - Street 1:700 PENNSYLVANIA AVE SE STE 2087
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2493
Practice Address - Country:US
Practice Address - Phone:202-408-7609
Practice Address - Fax:202-403-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty