Provider Demographics
NPI:1386257681
Name:HARRISON ELAMIN, MARY LOUISE (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:HARRISON ELAMIN
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 NAYLOR RD SE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4028
Mailing Address - Country:US
Mailing Address - Phone:202-664-0085
Mailing Address - Fax:
Practice Address - Street 1:8757 GEORGIA AVE STE 600
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3742
Practice Address - Country:US
Practice Address - Phone:301-652-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12089374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide