Provider Demographics
NPI:1902166598
Name:KAISA, THEODORA ADE (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:ADE
Last Name:KAISA
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 1:7904 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2634
Mailing Address - Country:US
Mailing Address - Phone:301-357-2749
Mailing Address - Fax:
Practice Address - Street 1:7904 25TH AVE
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-2634
Practice Address - Country:US
Practice Address - Phone:301-357-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDK200792031320374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide