Individual
KEICHA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
962 WAYNE AVE, SUITE 600, SILVER SPRING, MD 20910-4433
(301) 585-9595
Mailing address
962 WAYNE AVE, SUITE 600, SILVER SPRING, MD 20910-4433
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP34016
MD
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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