Healthcare Provider Details

I. General information

NPI: 1326072919
Provider Name (Legal Business Name): NETTIE D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 GEOFFREY WAY SUITE P
FREDERICK MD
21704-7106
US

IV. Provider business mailing address

PO BOX 27968
SALT LAKE CITY UT
84127-0968
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-3390
  • Fax: 301-694-9348
Mailing address:
  • Phone: 570-966-8030
  • Fax: 800-868-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number10200163
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN L MENCHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 407-822-4600