Provider Demographics
NPI:1922899590
Name:BOSTICK, KNEEWYNA VANSHONA
Entity type:Individual
Prefix:
First Name:KNEEWYNA
Middle Name:VANSHONA
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KNEEWYNA
Other - Middle Name:VANSHONA
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4004 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MORNINGSIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3403
Mailing Address - Country:US
Mailing Address - Phone:703-825-9530
Mailing Address - Fax:
Practice Address - Street 1:1634 D ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5508
Practice Address - Country:US
Practice Address - Phone:703-825-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant