Provider Demographics
NPI:1225403074
Name:AZANBOU, PELAGIE NINA NZUAZON (HHA)
Entity Type:Individual
Prefix:
First Name:PELAGIE NINA
Middle Name:NZUAZON
Last Name:AZANBOU
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 NEWTON ST NW APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1853
Mailing Address - Country:US
Mailing Address - Phone:443-824-2839
Mailing Address - Fax:
Practice Address - Street 1:1712 NEWTON ST APT 2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:443-824-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11649163WH0200X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA11649OtherHHA