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General NPI Number Information
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NPI Number | 1962867515
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Entity Type | Individual
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Provider Name | MAE FLORCENE WATTS HALL
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Gender | Female
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 1234 MASSACHUSETTS AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20005-4526
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Country | US
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Telephone | 26-382-3822
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Fax | 202-638-3169
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Provider Business Mailing Address
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Address Line | 3698 HAYES ST NE APT 201
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City | WASHINGTON
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State | DC
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Zip | 20019-7545
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Country | US
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Telephone | 202-506-3376
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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 | HHA10767
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License Number State | DC
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