Provider Demographics
NPI:1356482137
Name:JAWARA, BETH EKENMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:EKENMA
Last Name:JAWARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14504 FAIRDALE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6526
Mailing Address - Country:US
Mailing Address - Phone:202-877-9696
Mailing Address - Fax:202-877-9263
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-6162
Practice Address - Fax:301-891-5354
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN56583363L00000X
MDR109023363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care