Provider Demographics
NPI:1831674548
Name:CHANAA, MUTIAA ISSA
Entity Type:Individual
Prefix:MS
First Name:MUTIAA
Middle Name:ISSA
Last Name:CHANAA
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 1:2109 I ST NE APT 7
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3244
Mailing Address - Country:US
Mailing Address - Phone:202-749-0820
Mailing Address - Fax:
Practice Address - Street 1:2109 I ST NE APT 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3244
Practice Address - Country:US
Practice Address - Phone:202-749-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70462734OtherTRUSTED HEALTH PLAN