Provider Demographics
NPI:1336736743
Name:EKWEN, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:EKWEN
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 1:11292 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6732
Mailing Address - Country:US
Mailing Address - Phone:240-815-9689
Mailing Address - Fax:
Practice Address - Street 1:1220 12TH ST SE STE 350
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3727
Practice Address - Country:US
Practice Address - Phone:202-846-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide