Provider Demographics
NPI:1932720588
Name:MAKINDE, JACQUELINE ELAINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:MAKINDE
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 1:3744 HAYES STREET NE #1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-538-2291
Mailing Address - Fax:
Practice Address - Street 1:3744 HAYES ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1723
Practice Address - Country:US
Practice Address - Phone:202-538-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant