Provider Demographics
NPI:1215486659
Name:NICO, AMAH YAHSON
Entity type:Individual
Prefix:
First Name:AMAH
Middle Name:YAHSON
Last Name:NICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 RUATAN ST
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4312
Mailing Address - Country:US
Mailing Address - Phone:240-547-7032
Mailing Address - Fax:
Practice Address - Street 1:5612 RUATAN ST
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-4312
Practice Address - Country:US
Practice Address - Phone:240-547-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12383374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide