Provider Demographics
NPI:1790030237
Name:MICHEALS, DORTHY
Entity Type:Individual
Prefix:
First Name:DORTHY
Middle Name:
Last Name:MICHEALS
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 1:9917 GREENBELT RD
Mailing Address - Street 2:APT 203
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2246
Mailing Address - Country:US
Mailing Address - Phone:301-455-1846
Mailing Address - Fax:
Practice Address - Street 1:7506 GEORGIA AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide