Provider Demographics
NPI:1033655592
Name:IYAMAH-BROWN, PHILOMENA EBALU
Entity type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:EBALU
Last Name:IYAMAH-BROWN
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 1:2110 I ST NE
Mailing Address - Street 2:APT 302
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3256
Mailing Address - Country:US
Mailing Address - Phone:202-297-1094
Mailing Address - Fax:
Practice Address - Street 1:2110 I ST NE
Practice Address - Street 2:APT 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3256
Practice Address - Country:US
Practice Address - Phone:202-297-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12490374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide