Healthcare Provider Details

I. General information

NPI: 1780102988
Provider Name (Legal Business Name): YOLANDE MARIANIQUE KUTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 KREEGER DR APT 104
HYATTSVILLE MD
20783-6453
US

IV. Provider business mailing address

7905 KREEGER DR APT 104
HYATTSVILLE MD
20783-6453
US

V. Phone/Fax

Practice location:
  • Phone: 301-917-5645
  • Fax:
Mailing address:
  • Phone: 301-917-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12850
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: