Healthcare Provider Details

I. General information

NPI: 1164167995
Provider Name (Legal Business Name): PELAGIE ZITEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9357 WORRELL AVE
LANHAM MD
20706-3117
US

IV. Provider business mailing address

9357 WORRELL AVE
LANHAM MD
20706-3117
US

V. Phone/Fax

Practice location:
  • Phone: 202-940-3605
  • Fax:
Mailing address:
  • Phone: 202-940-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA00193434
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: