Etienne Dimbeck
Individual provider Active NPI Home Health Aide · Boturnsville, MD
NPI 1023430337 · NPPES record last updated Jan 7, 2014
Key facts
- NPI
- 1023430337
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- License
- HHA9092 (DC)
- Practice address
- 3671 Autumn Glenn Circle
Boturnsville, MD 20866 - Phone
- (443) 813-8209
- NPI assigned
- Jan 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HHA9092 | DC | MD | Home Health Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | HHA9092 | DC | Yes |
Addresses
Primary practice location
3671 Autumn Glenn Circle
Boturnsville, MD 20866
Mailing address
PO Box 1626
Columbia, MD 21044-0626
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.