MEDICARE: MISS CHANTEY EVAN THOMPSON

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	:	1952948226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHANTEY EVAN THOMPSON

Provider Business Mailing Address
First Line	:	2950 VAN NESS STREET N.W.
Second Line	:	312
City	:	WASHINGTON DC
State	:	DC
Zip	:	20008
Country	:	US
Telephone Number	:	202-905-5107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 POMEROY ROAD S.E.
Second Line	:	T-1
City	:	WASHINGTON
State	:	DC
Zip	:	20020-2002
Country	:	US
Telephone Number	:	202-248-2115
Fax Number	:

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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Directions to “ MISS CHANTEY EVAN THOMPSON ” Practice Location

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