Provider Demographics
NPI:1720842180
Name:PERRY-MCCLOUGH, ROWENA VENDETTE (PARTICIPANT DIRECTED)
Entity type:Individual
Prefix:MS
First Name:ROWENA
Middle Name:VENDETTE
Last Name:PERRY-MCCLOUGH
Suffix:
Gender:F
Credentials:PARTICIPANT DIRECTED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 DARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-5132
Mailing Address - Country:US
Mailing Address - Phone:202-413-9947
Mailing Address - Fax:
Practice Address - Street 1:6715 DARKWOOD CT
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-5132
Practice Address - Country:US
Practice Address - Phone:202-413-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant