MEDICARE: MS. ROWENA VENDETTE PERRY-MCCLOUGH PARTICIPANT DIRECTED

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1720842180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROWENA VENDETTE PERRY-MCCLOUGH PARTICIPANT DIRECTED

Provider Business Mailing Address
First Line	:	6715 DARKWOOD CT
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-5132
Country	:	US
Telephone Number	:	202-413-9947
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 DARKWOOD CT
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-5132
Country	:	US
Telephone Number	:	202-413-9947
Fax Number	:

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

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/09/2024

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