Provider Demographics
NPI:1851054886
Name:SIBACHA, PETRA TOKOLO
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:TOKOLO
Last Name:SIBACHA
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 1:2504 10TH ST NE APT A1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1701
Mailing Address - Country:US
Mailing Address - Phone:202-509-2773
Mailing Address - Fax:
Practice Address - Street 1:2504 10TH ST NE APT A1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1701
Practice Address - Country:US
Practice Address - Phone:202-509-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA1547374U00000X
390200000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program