Provider Demographics
NPI:1134895972
Name:BLAINE, DAQUANN BRYANT
Entity type:Individual
Prefix:
First Name:DAQUANN
Middle Name:BRYANT
Last Name:BLAINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4374 7TH ST SE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3567
Mailing Address - Country:US
Mailing Address - Phone:202-790-3655
Mailing Address - Fax:
Practice Address - Street 1:4374 7TH ST SE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3567
Practice Address - Country:US
Practice Address - Phone:202-790-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3747P1801XMedicaid