Provider Demographics
NPI:1740988179
Name:BASANTA, TARITA (RN)
Entity type:Individual
Prefix:
First Name:TARITA
Middle Name:
Last Name:BASANTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SKYLAND TER SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3455
Mailing Address - Country:US
Mailing Address - Phone:240-478-7164
Mailing Address - Fax:
Practice Address - Street 1:3417 18TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2721
Practice Address - Country:US
Practice Address - Phone:202-629-2917
Practice Address - Fax:202-629-2797
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1005714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC030960869Medicaid