Provider Demographics
NPI:1457966491
Name:METCHUM, ARIANE RAISSA
Entity Type:Individual
Prefix:
First Name:ARIANE
Middle Name:RAISSA
Last Name:METCHUM
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 1:11438 STEWART LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2226
Mailing Address - Country:US
Mailing Address - Phone:240-595-7759
Mailing Address - Fax:
Practice Address - Street 1:11438 STEWART LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2226
Practice Address - Country:US
Practice Address - Phone:240-595-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MD20201640376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20201640Medicaid