Healthcare Provider Details

I. General information

NPI: 1083941355
Provider Name (Legal Business Name): CHARDAE ANDREA WEEMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SCHOOL ST
BALTIMORE MD
21217-2828
US

IV. Provider business mailing address

1508 PENNSYLVANIA AVE APT 10
BALTIMORE MD
21217-3111
US

V. Phone/Fax

Practice location:
  • Phone: 410-736-9683
  • Fax: 410-669-3829
Mailing address:
  • Phone: 410-736-9683
  • Fax: 410-669-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00082196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: