Provider Demographics
NPI:1689938755
Name:LELAK, ANNIE GERTRUDE
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:GERTRUDE
Last Name:LELAK
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 1:6939 GEORGIA AVE NW
Mailing Address - Street 2:APT 518
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2456
Mailing Address - Country:US
Mailing Address - Phone:240-413-6713
Mailing Address - Fax:
Practice Address - Street 1:6939 GEORGIA AVE NW
Practice Address - Street 2:APT 518
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2456
Practice Address - Country:US
Practice Address - Phone:240-413-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00110959376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide