Provider Demographics
NPI:1851999239
Name:GWANYAMA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GWANYAMA
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 1:13302 DEERFIELD RD APT 204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2021
Mailing Address - Country:US
Mailing Address - Phone:443-687-2950
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVENUE NORTHWEST
Practice Address - Street 2:
Practice Address - City:WASHINGTON D.C
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-829-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1008929164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse