Provider Demographics
NPI:1356680375
Name:AWANDA, PRISCA E
Entity Type:Individual
Prefix:
First Name:PRISCA
Middle Name:E
Last Name:AWANDA
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 1:11700 OLD COLUMBIA PIKE
Mailing Address - Street 2:APT 1014
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:240-480-3989
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE
Practice Address - Street 2:APT 1014
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2579
Practice Address - Country:US
Practice Address - Phone:240-480-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1Medicaid