Provider Demographics
NPI:1508340787
Name:JAH, MARTHA E (CNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:JAH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 63RD PL
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1302
Mailing Address - Country:US
Mailing Address - Phone:240-765-9616
Mailing Address - Fax:
Practice Address - Street 1:3400 63RD PL
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1302
Practice Address - Country:US
Practice Address - Phone:240-765-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00000290376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide