MEDICARE: DANSON KHISA JR.

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	376K00000X	Nurse's Aide	A00148174	MD

General Provider Information

NPI Number	:	1518314210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANSON KHISA JR.

Provider Business Mailing Address
First Line	:	962 WAYNE AVE
Second Line	:	SUITE 600
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4433
Country	:	US
Telephone Number	:	301-585-9595
Fax Number	:	877-394-2171

Provider Business Practice Location Address
First Line	:	962 WAYNE AVE
Second Line	:	SUITE 600
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4433
Country	:	US
Telephone Number	:	301-585-9595
Fax Number	:	877-394-2171

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	05/23/2016

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