Healthcare Provider Details

I. General information

NPI: 1417596982
Provider Name (Legal Business Name): ANETTEE WOPENG NDAPAH EPSE MOSOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 57TH AVE APT A1
BLADENSBURG MD
20710-1660
US

IV. Provider business mailing address

6910 ALLISON ST APT C4
HYATTSVILLE MD
20784-2039
US

V. Phone/Fax

Practice location:
  • Phone: 301-364-7408
  • Fax:
Mailing address:
  • Phone: 301-364-7408
  • Fax: 301-364-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: