Provider Demographics
NPI:1386397610
Name:JENNINGS, WILLIE ANTHONY
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:ANTHONY
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 LORRING DR APT 102
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3416
Mailing Address - Country:US
Mailing Address - Phone:202-749-9955
Mailing Address - Fax:
Practice Address - Street 1:2549 ELVANS RD SE APT 401
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3531
Practice Address - Country:US
Practice Address - Phone:202-751-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant