Individual
INI UDOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3522 54TH AVE, APT. #1, HYATTSVILLE, MD 20784-1004
(202) 378-0957
Mailing address
3522 54TH AVE, APT. #1, HYATTSVILLE, MD 20784-1004
(202) 378-0957
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
NA00603449
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA00603449
CERTIFIED NURSING ASSISTANT
DC
Enumeration date
10/18/2016
Last updated
10/18/2016
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