Provider Demographics
NPI:1265182224
Name:RANSFORD, ANTWAINE
Entity type:Individual
Prefix:
First Name:ANTWAINE
Middle Name:
Last Name:RANSFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 CEDAR ST SE APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5009
Mailing Address - Country:US
Mailing Address - Phone:202-977-9401
Mailing Address - Fax:
Practice Address - Street 1:400 ATLANTIC ST SE APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3720
Practice Address - Country:US
Practice Address - Phone:202-977-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC91214818376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70449622Medicaid