Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 292267 | WV |
Y | 207R00000X | Internist | A75516 | CA |
Y | 111NI0900X | Internist | A75516 | CA |
NPI | 1538369830 |
---|---|
Provider Name | Nnemdi Elias |
First Address | Washington, DC 20006 |
Second Address | Washington, DC 20006-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 04/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A755160 | (05) | CA |
H66309 | (02) | CA |