Provider Demographics
NPI:1912483181
Name:EDORH-DAMLIN, FLORENCE M
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:M
Last Name:EDORH-DAMLIN
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 1:14119 CASTLE BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4734
Mailing Address - Country:US
Mailing Address - Phone:301-379-4088
Mailing Address - Fax:
Practice Address - Street 1:14119 CASTLE BLVD APT 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-379-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13801374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13801Medicaid