Provider Demographics
NPI:1699457820
Name:O'BANNON, AMELIA RAMONA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:RAMONA
Last Name:O'BANNON
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 1:1818 NEW YORK AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1849
Mailing Address - Country:US
Mailing Address - Phone:202-506-5187
Mailing Address - Fax:
Practice Address - Street 1:1611 17TH ST SE APT 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5563
Practice Address - Country:US
Practice Address - Phone:202-500-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator