Provider Demographics
NPI:1053941054
Name:CLARK, AYANAH
Entity type:Individual
Prefix:PROF
First Name:AYANAH
Middle Name:
Last Name:CLARK
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 1:3298 FORT LINCOLN DR NE APT 1010
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4342
Mailing Address - Country:US
Mailing Address - Phone:202-607-4381
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 1010
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4342
Practice Address - Country:US
Practice Address - Phone:202-709-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant