Provider Demographics
NPI:1134502495
Name:ISAAC, MEDHANIE DANIEL
Entity Type:Individual
Prefix:
First Name:MEDHANIE
Middle Name:DANIEL
Last Name:ISAAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ANNE ST
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7558
Mailing Address - Country:US
Mailing Address - Phone:202-290-4209
Mailing Address - Fax:
Practice Address - Street 1:813 ANNE ST
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7558
Practice Address - Country:US
Practice Address - Phone:202-290-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11362374U00000X
DCNA00606847376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide