=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326454265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ROCKEFELLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2014
-----------------------------------------------------
Last Update Date | 05/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 LYMAN PL NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20002-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-636-1130
-----------------------------------------------------
Fax | 202-636-1132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 RITTENHOUSE ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-287-7589
-----------------------------------------------------
Fax | 202-854-7825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HHA12667
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN1010260
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------