Provider Demographics
NPI:1578331898
Name:PRINCE, DEIONNA ELLERI
Entity Type:Individual
Prefix:
First Name:DEIONNA
Middle Name:ELLERI
Last Name:PRINCE
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 1:2401 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5815
Mailing Address - Country:US
Mailing Address - Phone:877-659-4500
Mailing Address - Fax:
Practice Address - Street 1:1820 TRENTON PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7650
Practice Address - Country:US
Practice Address - Phone:202-415-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health