Provider Demographics
NPI:1629347174
Name:JAKIMAVICIENE, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:JAKIMAVICIENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18041 COTTAGE GARDEN DR APT 203
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5816
Mailing Address - Country:US
Mailing Address - Phone:410-814-9803
Mailing Address - Fax:
Practice Address - Street 1:18041 COTTAGE GARDEN DR APT 203
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5816
Practice Address - Country:US
Practice Address - Phone:410-814-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024757000OtherMEDICAID PROVIDER NUMBER
MD5024757000OtherNPI ON DHMH