Individual
SAMARA KACHE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 CAPITOL HEIGHTS BLVD, CAPITOL HEIGHTS, MD 20743-2901
(202) 839-6862
Mailing address
634 CAPITOL HEIGHTS BLVD, CAPITOL HEIGHTS, MD 20743-2901
(202) 839-6862
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
—
—
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
12/23/2019
Last updated
12/23/2019
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