Provider Demographics
NPI:1497319255
Name:DE JESUS, HONORATA LAGMAN
Entity Type:Individual
Prefix:
First Name:HONORATA
Middle Name:LAGMAN
Last Name:DE JESUS
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 1:604 KENNEDY ST NW APT 35
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3002
Mailing Address - Country:US
Mailing Address - Phone:202-717-0228
Mailing Address - Fax:
Practice Address - Street 1:604 KENNEDY ST NW APT 35
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3002
Practice Address - Country:US
Practice Address - Phone:202-717-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12815374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2595894OtherDC STATE ID