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General NPI Number Information
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NPI Number | 1497817373
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Entity Type | Individual
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Provider Name | MRS. CLAUDETTE EMMELINE DEMETRIUS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 16220 FREDRICK AVE #12
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City | GEITHERSBERG
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State | MD
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Zip | 20877
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Country | US
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Telephone | 301-208-0775
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Fax |
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Provider Business Mailing Address
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Address Line | 13529 GEORGIA AVE APARTMENT 203
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City | SILVER SPRING
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State | MD
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Zip | 20906
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Country | US
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Telephone | 301-946-3338
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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 | 991558
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | A00015852
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License Number State | MD
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