Provider Demographics
NPI:1922351915
Name:KETONZE, JUSTIN NANJI
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:NANJI
Last Name:KETONZE
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 1:9116 PINEY BRANCH RD APT 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2818
Mailing Address - Country:US
Mailing Address - Phone:240-505-0683
Mailing Address - Fax:
Practice Address - Street 1:9116 PINEY BRANCH RD APT 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2818
Practice Address - Country:US
Practice Address - Phone:240-505-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN1062530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide