Provider Demographics
NPI:1235689043
Name:ROBERTSON, ANTWANAE VALECHEZ
Entity Type:Individual
Prefix:
First Name:ANTWANAE
Middle Name:VALECHEZ
Last Name:ROBERTSON
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 1:3312 14TH PL SE APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4706
Mailing Address - Country:US
Mailing Address - Phone:202-644-2460
Mailing Address - Fax:
Practice Address - Street 1:3312 14TH PL SE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4706
Practice Address - Country:US
Practice Address - Phone:202-644-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12394374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide