MEDICARE: EVELYN ASONGU A E FORCHENMBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA13095	DC

General Provider Information

NPI Number	:	1073032066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN ASONGU A E FORCHENMBIN

Provider Business Mailing Address
First Line	:	3518 54TH AVE APT 2
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1004
Country	:	US
Telephone Number	:	240-696-9675
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 54TH AVE APT 2
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1004
Country	:	US
Telephone Number	:	240-696-9675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/21/2022

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