Individual
GRACIOUS WEAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA-DT
Contact information
Practice address
8603 GRAY FOX RD APT 203, RANDALLSTOWN, MD 21133-5145
(443) 565-2619
Mailing address
8603 GRAY FOX RD APT 203, RANDALLSTOWN, MD 21133-5145
(443) 565-2619
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
843936784
HOME HEALTHCARE
—
Enumeration date
12/11/2019
Last updated
12/11/2019
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