Provider Demographics
NPI:1114598687
Name:ELLIOTT, MYISHA NICOLE
Entity Type:Individual
Prefix:
First Name:MYISHA
Middle Name:NICOLE
Last Name:ELLIOTT
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:PO BOX 91953
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20090-1953
Mailing Address - Country:US
Mailing Address - Phone:202-836-5335
Mailing Address - Fax:
Practice Address - Street 1:4113 STANLEY ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5629
Practice Address - Country:US
Practice Address - Phone:202-836-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant