Provider Demographics
NPI:1467261339
Name:FON NWIEKERI, KAH BLANDINE
Entity type:Individual
Prefix:
First Name:KAH BLANDINE
Middle Name:
Last Name:FON NWIEKERI
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 1:3333 BUCHANAN ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1122
Mailing Address - Country:US
Mailing Address - Phone:240-564-0726
Mailing Address - Fax:
Practice Address - Street 1:3831 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1309
Practice Address - Country:US
Practice Address - Phone:202-583-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALICSW171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator