Provider Demographics
NPI:1598218265
Name:ETANKI, CLAUDINE
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:
Last Name:ETANKI
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 1:7851 RIVERDALE RD
Mailing Address - Street 2:APT T3
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4004
Mailing Address - Country:US
Mailing Address - Phone:240-467-4620
Mailing Address - Fax:
Practice Address - Street 1:7851 RIVERDALE RD
Practice Address - Street 2:APT T3
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4004
Practice Address - Country:US
Practice Address - Phone:240-467-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12259374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide