MEDICARE: KEASHA HANNAH NURSING ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency		MD
2	3747P1801X	Personal Care Attendant		MD

General Provider Information

NPI Number	:	1083246854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEASHA HANNAH NURSING ASSISTANT

Provider Business Mailing Address
First Line	:	4139 W FOREST PARK AVE FL 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-7408
Country	:	US
Telephone Number	:	443-410-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4139 W FOREST PARK AVE FL 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-7408
Country	:	US
Telephone Number	:	443-410-9544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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