Individual
MRS. GENEVIVE WUTANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12423 RONALD BEALL RD, UPPER MARLBORO, MD 20774-5686
(240) 828-9004
Mailing address
6103 ERIKA PL, GLENN DALE, MD 20769-9220
(240) 828-9004
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
10/06/2020
Last updated
07/07/2023
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