Provider Demographics
NPI:1265931125
Name:WELLINGTON, CECILIAMARIE E
Entity type:Individual
Prefix:
First Name:CECILIAMARIE
Middle Name:E
Last Name:WELLINGTON
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 1:6648 24TH PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1712
Mailing Address - Country:US
Mailing Address - Phone:240-619-9387
Mailing Address - Fax:
Practice Address - Street 1:901 1ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1403
Practice Address - Country:US
Practice Address - Phone:202-282-3011
Practice Address - Fax:202-282-2057
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000811050376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNA0000811050OtherCNA