Provider Demographics
NPI:1124453873
Name:MOTSUMI HAYNES, MONICAH NGWAANANG
Entity type:Individual
Prefix:MRS
First Name:MONICAH
Middle Name:NGWAANANG
Last Name:MOTSUMI HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONICAH
Other - Middle Name:NGWAANANG
Other - Last Name:MOTSUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 24TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2126
Mailing Address - Country:US
Mailing Address - Phone:202-832-8340
Mailing Address - Fax:
Practice Address - Street 1:2512 24TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2126
Practice Address - Country:US
Practice Address - Phone:202-832-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9573374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide