Healthcare Provider Details

I. General information

NPI: 1205176724
Provider Name (Legal Business Name): MARY EFENURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 TOWNSEND WAY APT. C-4
BLADENSBURG MD
20710-1854
US

IV. Provider business mailing address

5016 TOWNSEND WAY APT. C-4
BLADENSBURG MD
20710-1854
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-8245
  • Fax:
Mailing address:
  • Phone: 240-413-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: