MEDICARE: BERNICE MCCALLUM

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	:	1871146548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNICE MCCALLUM

Provider Business Mailing Address
First Line	:	1336 MISSOURI AVE NW APT 321
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1840
Country	:	US
Telephone Number	:	202-726-5852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 MISSOURI AVE. N.W #321
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011
Country	:	US
Telephone Number	:	202-726-5852
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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Directions to “ BERNICE MCCALLUM ” Practice Location

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