MEDICARE: PRISCA E AWANDA

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		DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356680375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCA E AWANDA

Provider Business Mailing Address
First Line	:	11700 OLD COLUMBIA PIKE
Second Line	:	APT 1014
City	:	SILVER SPRING
State	:	MD
Zip	:	20904
Country	:	US
Telephone Number	:	240-480-3989
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 OLD COLUMBIA PIKE
Second Line	:	APT 1014
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2579
Country	:	US
Telephone Number	:	240-480-3989
Fax Number	:

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

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	02/11/2013

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Directions to “ PRISCA E AWANDA ” Practice Location

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