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General NPI Number Information
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NPI Number | 1316477425
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Entity Type | Individual
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Provider Name | ZACKERY WASHINGTON
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Gender | Male
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/13/2017
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Provider Practice Location Address
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Address Line | 11847 TOWER HAMLETS PL
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City | WALDORF
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State | MD
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Zip | 20602-6122
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Country | US
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Telephone | 301-383-5308
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 956
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City | WHITE PLAINS
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State | MD
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Zip | 20695-0956
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Country | US
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Telephone | 301-383-5308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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