Provider Demographics
NPI:1164980157
Name:CHENWI, CLIFSON
Entity Type:Individual
Prefix:
First Name:CLIFSON
Middle Name:
Last Name:CHENWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 REED ST APT 2132
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1547
Mailing Address - Country:US
Mailing Address - Phone:240-478-0155
Mailing Address - Fax:
Practice Address - Street 1:3200 REED ST APT 2132
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1547
Practice Address - Country:US
Practice Address - Phone:240-478-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14327374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide