Provider Demographics
NPI:1790352425
Name:WARD, IMANI SYRETTA
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:SYRETTA
Last Name:WARD
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 1:3247 WESTDALE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2917
Mailing Address - Country:US
Mailing Address - Phone:301-659-7170
Mailing Address - Fax:
Practice Address - Street 1:21 ATLANTIC ST SW APT 403
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2357
Practice Address - Country:US
Practice Address - Phone:202-412-5592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant