Provider Demographics
NPI:1700135746
Name:WAJID-ALI, EDWINA GLORIA (RN)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:GLORIA
Last Name:WAJID-ALI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:GLORIA
Other - Last Name:TEFERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3205 HENSON RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2957
Mailing Address - Country:US
Mailing Address - Phone:202-316-3013
Mailing Address - Fax:202-563-5657
Practice Address - Street 1:3205 HENSON RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2957
Practice Address - Country:US
Practice Address - Phone:202-316-3013
Practice Address - Fax:202-563-5657
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN40322163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice