Healthcare Provider Details

I. General information

NPI: 1417424417
Provider Name (Legal Business Name): KELLY NJOHJAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2018
Last Update Date: 10/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9917 GOOD LUCK RD APT 104
LANHAM MD
20706-3252
US

IV. Provider business mailing address

9917 GOOD LUCK RD APT 104
LANHAM MD
20706-3252
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-0969
  • Fax:
Mailing address:
  • Phone: 240-413-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14073
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: