Provider Demographics
NPI:1740459163
Name:THURSTON GNAHOUI, WANDA LATEYCE (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LATEYCE
Last Name:THURSTON GNAHOUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HOWARD RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5805
Mailing Address - Country:US
Mailing Address - Phone:202-698-2330
Mailing Address - Fax:202-698-2466
Practice Address - Street 1:821 HOWARD RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5805
Practice Address - Country:US
Practice Address - Phone:202-698-2330
Practice Address - Fax:202-698-2466
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD324162084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry