Provider Demographics
NPI:1689449613
Name:WOMACK, CHELESIE
Entity Type:Individual
Prefix:
First Name:CHELESIE
Middle Name:
Last Name:WOMACK
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 1:2101 ADDISON RD S APT 2
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1501
Mailing Address - Country:US
Mailing Address - Phone:202-617-4249
Mailing Address - Fax:
Practice Address - Street 1:3096 STANTON RD SE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7804
Practice Address - Country:US
Practice Address - Phone:202-993-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant