Provider Demographics
NPI:1669816120
Name:NANA, JEAN GAUDIN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:GAUDIN
Last Name:NANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13227 VERDI CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6891
Mailing Address - Country:US
Mailing Address - Phone:202-299-7377
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1316
Practice Address - Country:US
Practice Address - Phone:202-545-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide