Provider Demographics
NPI:1578215133
Name:CAROLINE, ANTONELLE D
Entity Type:Individual
Prefix:MISS
First Name:ANTONELLE
Middle Name:D
Last Name:CAROLINE
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 1:4233 BLAINE ST NE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4588
Mailing Address - Country:US
Mailing Address - Phone:202-579-4680
Mailing Address - Fax:
Practice Address - Street 1:900 5TH ST SE APT 310
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4507
Practice Address - Country:US
Practice Address - Phone:202-808-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant