Individual
BREONA CHANEL WASHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6974 WALKER MILL RD APT A1, CAPITOL HEIGHTS, MD 20743
(202) 903-4579
Mailing address
6974 WALKER MILL RD APT A1, CAPITOL HEIGHTS, MD 20743
(202) 903-4579
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
3646226
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3646226
DRIVER LICENSE
DC
Enumeration date
06/10/2020
Last updated
06/10/2020
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