Healthcare Provider Details

I. General information

NPI: 1780923870
Provider Name (Legal Business Name): UTA MICHELLE ANDERSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 N CALVERT ST
BALTIMORE MD
21202-2804
US

IV. Provider business mailing address

1614 N CALVERT ST
BALTIMORE MD
21202-2804
US

V. Phone/Fax

Practice location:
  • Phone: 410-659-4062
  • Fax:
Mailing address:
  • Phone: 410-659-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA00078002
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00078002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: