MEDICARE: KEVICHE LAWS RN

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	163WH0200X	Home Health Registered Nurse	RN622566	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41663601	OTHER	PA	DEPARTMENT OF HEALTH HOME CARE LICENSE

General Provider Information

NPI Number	:	1760015390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVICHE LAWS RN

Provider Business Mailing Address
First Line	:	6145 ERDRICK ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19135-3516
Country	:	US
Telephone Number	:	215-200-6410
Fax Number	:	215-457-6500

Provider Business Practice Location Address
First Line	:	1103 WINDRIM AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19141-2817
Country	:	US
Telephone Number	:	215-457-6400
Fax Number	:	215-457-6500

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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Directions to “ KEVICHE LAWS RN” Practice Location

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