Provider Demographics
NPI:1568723013
Name:BASONDWA, LAETITIA N
Entity Type:Individual
Prefix:
First Name:LAETITIA
Middle Name:N
Last Name:BASONDWA
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 1:53 CRITTENDEN ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6719
Mailing Address - Country:US
Mailing Address - Phone:703-589-8895
Mailing Address - Fax:
Practice Address - Street 1:53 CRITTENDEN ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6719
Practice Address - Country:US
Practice Address - Phone:703-589-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide