Provider Demographics
NPI:1932779402
Name:MILES, CHARDEA LYN-NESSE
Entity type:Individual
Prefix:
First Name:CHARDEA
Middle Name:LYN-NESSE
Last Name:MILES
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 1:2514 4TH ST NE APT 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1243
Mailing Address - Country:US
Mailing Address - Phone:240-707-5778
Mailing Address - Fax:
Practice Address - Street 1:5210 3RD ST NE APT 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6335
Practice Address - Country:US
Practice Address - Phone:202-468-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant