Provider Demographics
NPI:1578139002
Name:EKWET, SOPHIE T
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:T
Last Name:EKWET
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 1:2230 BRIGHTSEAT RD APT 302
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3520
Mailing Address - Country:US
Mailing Address - Phone:804-549-8498
Mailing Address - Fax:
Practice Address - Street 1:1400 FLORIDA AVE NE APT 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5010
Practice Address - Country:US
Practice Address - Phone:804-549-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE-230-772-785-739Medicaid
DCE-230-772-785-739Medicaid