Provider Demographics
NPI:1891496477
Name:CHAVERS, AMANDA JACQUELINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JACQUELINE
Last Name:CHAVERS
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 1:4913 JUST ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4872
Mailing Address - Country:US
Mailing Address - Phone:202-403-9750
Mailing Address - Fax:
Practice Address - Street 1:4656 LIVINGSTON RD SE APT 537
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3173
Practice Address - Country:US
Practice Address - Phone:202-597-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant