Provider Demographics
NPI:1427486919
Name:JOHNNY, AMIE JATTU
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:JATTU
Last Name:JOHNNY
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 1:3223 TOLEDO PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4132
Mailing Address - Country:US
Mailing Address - Phone:240-490-0940
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW TORK AVE STE 117
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:MD
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-269-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide