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NPI Code Detail

MEDICARE: CLAUDINE ETIH MBA

MEDICARE: CLAUDINE ETIH MBA
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
1374U00000XHome Health AideHHA11412DC

General Provider Information

NPI Number : 1568907434
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAUDINE ETIH MBA
Provider Business Mailing Address
First Line : 7401 NEW HAMPSHIRE AVE APT 1111
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-6955
Country : US
Telephone Number : 240-392-7049
Fax Number :
Provider Business Practice Location Address
First Line : 7401 NEW HAMPSHIRE AVE APT 1111
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-6955
Country : US
Telephone Number : 240-392-7049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2016
Last Update Date : 12/30/2016

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