Basic Information
| Provider Information | |||||||||
| NPI: | 1740459163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THURSTON GNAHOUI | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | LATEYCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 HOWARD RD SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200205805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026982330 | ||||||||
| FaxNumber: | 2026982466 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 HOWARD RD SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200205805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026982330 | ||||||||
| FaxNumber: | 2026982466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2008 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MD32416 | DC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.