Provider Demographics
NPI:1114567583
Name:KRITIKOS, IRENE MELISA
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MELISA
Last Name:KRITIKOS
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 1:143 KENNEDY ST NW STE 15
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5268
Mailing Address - Country:US
Mailing Address - Phone:240-602-1506
Mailing Address - Fax:
Practice Address - Street 1:5453 MADISON WAY APT 11
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1055
Practice Address - Country:US
Practice Address - Phone:240-602-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15045374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide