MEDICARE: VAN GAITHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1376053397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAN GAITHER

Provider Business Mailing Address
First Line	:	3520 6TH ST SE APT 2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 6TH ST SE APT 2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3843
Country	:	US
Telephone Number	:	202-617-8832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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Directions to “ VAN GAITHER ” Practice Location

Language	Start Address	Practice Location

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