Provider Demographics
NPI:1982474268
Name:PROCTOR, GIANNI DAJAHENA
Entity Type:Individual
Prefix:
First Name:GIANNI
Middle Name:DAJAHENA
Last Name:PROCTOR
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 1:716 12TH ST SE APT 22
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2969
Mailing Address - Country:US
Mailing Address - Phone:202-941-7769
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 1014
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4038
Practice Address - Country:US
Practice Address - Phone:202-446-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant