Healthcare Provider Details

I. General information

NPI: 1902166630
Provider Name (Legal Business Name): VICTORINE NAAH CHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 HAMILTON ST
HYATTSVILLE MD
20782-3953
US

IV. Provider business mailing address

9407 BLUEFIELD RD
SPRINGDALE MD
20774-5435
US

V. Phone/Fax

Practice location:
  • Phone: 301-363-0707
  • Fax:
Mailing address:
  • Phone: 240-752-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1032611
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR211820
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: