MEDICARE: MARY AIZENOFE

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	376K00000X	Nurse's Aide	A00155811	MD

General Provider Information

NPI Number	:	1124695077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY AIZENOFE

Provider Business Mailing Address
First Line	:	350 E DIAMOND AVE APT 3070
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-3262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 E DIAMOND AVE APT 3070
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-3262
Country	:	US
Telephone Number	:	240-855-8906
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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Directions to “ MARY AIZENOFE ” Practice Location

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