Healthcare Provider Details

I. General information

NPI: 1730433194
Provider Name (Legal Business Name): ELOISE EME ANNAH GNA ,HHA,CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KAY CT APT 204
LAUREL MD
20707-5143
US

IV. Provider business mailing address

5625 ALLENTOWN RD
CAMP SPRINGS MD
20746-4521
US

V. Phone/Fax

Practice location:
  • Phone: 240-715-5682
  • Fax:
Mailing address:
  • Phone: 301-899-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberA00112109
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: