Healthcare Provider Details

I. General information

NPI: 1881510923
Provider Name (Legal Business Name): ETONGWE MENDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 BROOKS DR
DISTRICT HEIGHTS MD
20747-1060
US

IV. Provider business mailing address

2020 BROOKS DR
DISTRICT HEIGHTS MD
20747-1060
US

V. Phone/Fax

Practice location:
  • Phone: 912-272-8490
  • Fax:
Mailing address:
  • Phone: 912-272-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006543
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: