Healthcare Provider Details

I. General information

NPI: 1942622410
Provider Name (Legal Business Name): ELANA COUPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 MAURICE CT
MONROVIA MD
21770-9118
US

IV. Provider business mailing address

3906 MAURICE COURT
MONROVIA MD
21770
US

V. Phone/Fax

Practice location:
  • Phone: 301-471-1442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00116458
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: