Provider Demographics
NPI:1891461851
Name:TWENBOA, CHRISTIANA N/A
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:N/A
Last Name:TWENBOA
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 1:10379B DEMOCRACY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2505
Mailing Address - Country:US
Mailing Address - Phone:703-679-7856
Mailing Address - Fax:
Practice Address - Street 1:10379B DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2505
Practice Address - Country:US
Practice Address - Phone:703-679-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program