Healthcare Provider Details

I. General information

NPI: 1972119774
Provider Name (Legal Business Name): JUDITH-BELLE TIFUH ENOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 75TH AVE APT 205
LANDOVER MD
20785-1509
US

IV. Provider business mailing address

3211 75TH AVE APT 205
LANDOVER MD
20785-1932
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-2054
  • Fax:
Mailing address:
  • Phone: 240-422-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00159924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: