Healthcare Provider Details

I. General information

NPI: 1568969251
Provider Name (Legal Business Name): FORTAW SCHOLASTICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 GROSVENOR PL APT 802
ROCKVILLE MD
20852-4635
US

IV. Provider business mailing address

8757 GEORGIA AVE STE 600
SILVER SPRING MD
20910-3742
US

V. Phone/Fax

Practice location:
  • Phone: 240-421-6797
  • Fax:
Mailing address:
  • Phone: 301-652-7212
  • Fax: 301-263-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberNA0000805170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: