MEDICARE: MANYI ARREY JOVITA ETCHU

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1255109955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANYI ARREY JOVITA ETCHU

Provider Business Mailing Address
First Line	:	6600 TALL WOODS WAY
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-3871
Country	:	US
Telephone Number	:	202-961-3959
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 TALL WOODS WAY
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-3871
Country	:	US
Telephone Number	:	202-961-3959
Fax Number	:

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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Directions to “ MANYI ARREY JOVITA ETCHU ” Practice Location

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