Provider Demographics
NPI:1205505195
Name:ELWELL, VIVIAN ANNE
Entity type:Individual
Prefix:MISS
First Name:VIVIAN
Middle Name:ANNE
Last Name:ELWELL
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 1:5101 MACOMB ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2611
Mailing Address - Country:US
Mailing Address - Phone:202-244-4386
Mailing Address - Fax:
Practice Address - Street 1:5101 MACOMB ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2611
Practice Address - Country:US
Practice Address - Phone:202-244-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant