Provider Demographics
NPI:1720341324
Name:WANKI, PATRICE (HHA)
Entity Type:Individual
Prefix:MR
First Name:PATRICE
Middle Name:
Last Name:WANKI
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 BRICKYARD BLVD APT 1036
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1346
Mailing Address - Country:US
Mailing Address - Phone:240-386-7280
Mailing Address - Fax:
Practice Address - Street 1:2501 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3011
Practice Address - Country:US
Practice Address - Phone:240-386-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide