MEDICARE: ODETTE WAGOH MPONG EPOUSE FORBIYEH

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

General Provider Information

NPI Number	:	1356233563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODETTE WAGOH MPONG EPOUSE FORBIYEH

Provider Business Mailing Address
First Line	:	3354 CHILLUM RD APT 301
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1140
Country	:	US
Telephone Number	:	301-254-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3354 CHILLUM RD APT 301
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1140
Country	:	US
Telephone Number	:	301-254-7570
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “ ODETTE WAGOH MPONG EPOUSE FORBIYEH ” Practice Location

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