Healthcare Provider Details

I. General information

NPI: 1326903667
Provider Name (Legal Business Name): NELLY POUATCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 FAIRVIEW AVE
TAKOMA PARK MD
20912-5979
US

IV. Provider business mailing address

790 FAIRVIEW AVE
TAKOMA PARK MD
20912-5979
US

V. Phone/Fax

Practice location:
  • Phone: 469-937-0111
  • Fax:
Mailing address:
  • Phone: 469-937-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005731
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: