Provider Demographics
NPI:1417636267
Name:FAISON, ETHEL PEARL
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:PEARL
Last Name:FAISON
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 1:721 DELAFIELD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2349
Mailing Address - Country:US
Mailing Address - Phone:202-971-0040
Mailing Address - Fax:
Practice Address - Street 1:3090 STANTON RD SE # E201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7855
Practice Address - Country:US
Practice Address - Phone:202-568-3077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide