Healthcare Provider Details

I. General information

NPI: 1699802868
Provider Name (Legal Business Name): MRS. ANTOINETTE S. MACER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 LENNOX ST APT D
BALTIMORE MD
21217-4614
US

IV. Provider business mailing address

755 LENNOX ST APT D
BALTIMORE MD
21217-4614
US

V. Phone/Fax

Practice location:
  • Phone: 443-857-2554
  • Fax:
Mailing address:
  • Phone: 443-857-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: