Healthcare Provider Details

I. General information

NPI: 1316676349
Provider Name (Legal Business Name): NOELLAR UCHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13184 LARCHDALE RD
LAUREL MD
20708-1707
US

IV. Provider business mailing address

13184 LARCHDALE RD
LAUREL MD
20708-1707
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA00200327
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number1316676349
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: