Provider Demographics
NPI:1316683816
Name:CORBETT, KATIAH IKIAH
Entity type:Individual
Prefix:MISS
First Name:KATIAH
Middle Name:IKIAH
Last Name:CORBETT
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 1:6260 MAXWELL DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4131
Mailing Address - Country:US
Mailing Address - Phone:202-221-1638
Mailing Address - Fax:
Practice Address - Street 1:3501 WHEELER RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4140
Practice Address - Country:US
Practice Address - Phone:202-421-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86FFA79E3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant