Provider Demographics
NPI:1427888460
Name:WASHINGTON, JAMELLA ARTELIA
Entity type:Individual
Prefix:
First Name:JAMELLA
Middle Name:ARTELIA
Last Name:WASHINGTON
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 1:880 BOYNTON AVE APT 16J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4631
Mailing Address - Country:US
Mailing Address - Phone:917-250-1165
Mailing Address - Fax:
Practice Address - Street 1:880 BOYNTON AVE APT 16J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4631
Practice Address - Country:US
Practice Address - Phone:917-250-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY818428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty