Provider Demographics
NPI:1336818822
Name:MONROE, DAVITA THEARTIS
Entity type:Individual
Prefix:MS
First Name:DAVITA
Middle Name:THEARTIS
Last Name:MONROE
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 1:3211 WALTERS LN APT 203
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3110
Mailing Address - Country:US
Mailing Address - Phone:202-569-1660
Mailing Address - Fax:
Practice Address - Street 1:1850 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2810
Practice Address - Country:US
Practice Address - Phone:202-678-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant