MEDICARE: NOBASHEA HOUSE

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	225700000X	Massage Therapist		MD
2	374J00000X	Doula		MD

General Provider Information

NPI Number	:	1407580517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOBASHEA HOUSE

Provider Business Mailing Address
First Line	:	7029 EVERGREEN DR
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-3334
Country	:	US
Telephone Number	:	240-280-6130
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 FARRAGUT ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2032
Country	:	US
Telephone Number	:	301-266-5832
Fax Number	:

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

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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Directions to “ NOBASHEA HOUSE ” Practice Location

Language	Start Address	Practice Location

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