Provider Demographics
NPI:1609467497
Name:ABDULNAZEEM, KAFAYAT TIWALOLA
Entity Type:Individual
Prefix:
First Name:KAFAYAT
Middle Name:TIWALOLA
Last Name:ABDULNAZEEM
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 1:1221 TAYLOR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5617
Mailing Address - Country:US
Mailing Address - Phone:347-798-6943
Mailing Address - Fax:
Practice Address - Street 1:1221 TAYLOR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5617
Practice Address - Country:US
Practice Address - Phone:347-798-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000812278374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide