Provider Demographics
NPI:1811300569
Name:EFUETLANCHA, STELLA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:EFUETLANCHA
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 1:1813 GREENWICH WOOD DR
Mailing Address - Street 2:APT 24
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2121
Mailing Address - Country:US
Mailing Address - Phone:301-917-4822
Mailing Address - Fax:
Practice Address - Street 1:1813 GREENWICH WOOD DR
Practice Address - Street 2:APT 24
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2121
Practice Address - Country:US
Practice Address - Phone:301-917-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide