Provider Demographics
NPI:1669022422
Name:NFON JULLIET, AZAH
Entity Type:Individual
Prefix:
First Name:AZAH
Middle Name:
Last Name:NFON JULLIET
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 1:7506 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1608
Mailing Address - Country:US
Mailing Address - Phone:202-291-6973
Mailing Address - Fax:
Practice Address - Street 1:7009 HIGHVIEW TER APT 101
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4034
Practice Address - Country:US
Practice Address - Phone:240-713-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1053037163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse