Healthcare Provider Details

I. General information

NPI: 1790197887
Provider Name (Legal Business Name): MARY OBASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9954 ELM ST
LANHAM MD
20706-4712
US

IV. Provider business mailing address

9954 ELM ST
LANHAM MD
20706-4712
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-6615
  • Fax:
Mailing address:
  • Phone: 202-531-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA10307
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: