Healthcare Provider Details

I. General information

NPI: 1700790573
Provider Name (Legal Business Name): COLLETTE KEWAE EPSE FONZENYUY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 RED WING LN
LANHAM MD
20706-3858
US

IV. Provider business mailing address

8503 RED WING LN
LANHAM MD
20706-3858
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-1790
  • Fax:
Mailing address:
  • Phone: 301-728-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006511
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: