Provider Demographics
NPI:1346860517
Name:EBOT, PIERRETTE A (HHA)
Entity Type:Individual
Prefix:MISS
First Name:PIERRETTE
Middle Name:A
Last Name:EBOT
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MERCANTILE LN STE 127
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5382
Mailing Address - Country:US
Mailing Address - Phone:240-224-6871
Mailing Address - Fax:
Practice Address - Street 1:1450 MERCANTILE LN STE 127
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5382
Practice Address - Country:US
Practice Address - Phone:240-224-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA15060163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty