Healthcare Provider Details

I. General information

NPI: 1912679028
Provider Name (Legal Business Name): CHARISSA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6814 CENTRAL AVE APT 404
CAPITOL HEIGHTS MD
20743-2790
US

IV. Provider business mailing address

6814 CENTRAL AVE APT 404
CAPITOL HEIGHTS MD
20743-2790
US

V. Phone/Fax

Practice location:
  • Phone: 202-288-0737
  • Fax:
Mailing address:
  • Phone: 202-288-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0910048513
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA0000811468
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: