Provider Demographics
NPI:1720698251
Name:VENABLE, MARY LUCILLE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUCILLE
Last Name:VENABLE
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 1:3060 30TH ST SE APT 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1650
Mailing Address - Country:US
Mailing Address - Phone:202-903-8324
Mailing Address - Fax:
Practice Address - Street 1:1221 M ST NW APT 816
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5164
Practice Address - Country:US
Practice Address - Phone:202-789-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant