Provider Demographics
NPI:1861255358
Name:LONG-OPHER, PROKOSHIA
Entity type:Individual
Prefix:
First Name:PROKOSHIA
Middle Name:
Last Name:LONG-OPHER
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 1:443 XENIA ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3723
Mailing Address - Country:US
Mailing Address - Phone:202-878-5539
Mailing Address - Fax:
Practice Address - Street 1:443 XENIA ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3723
Practice Address - Country:US
Practice Address - Phone:202-878-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant