Provider Demographics
NPI:1699230045
Name:BUCKNER, DENICE LASHAWN
Entity Type:Individual
Prefix:
First Name:DENICE
Middle Name:LASHAWN
Last Name:BUCKNER
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 1:4800 NANNIE HELEN BURROUGHS AVE NE APT 402
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3770
Mailing Address - Country:US
Mailing Address - Phone:301-655-8720
Mailing Address - Fax:
Practice Address - Street 1:4800 NANNIE HELEN BURROUGHS AVE NE APT 402
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3770
Practice Address - Country:US
Practice Address - Phone:301-655-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide