Healthcare Provider Details

I. General information

NPI: 1740942291
Provider Name (Legal Business Name): MARCELINE ENJEI WEREBESSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13906 BRIARWOOD DR APT 2322
LAUREL MD
20708-1334
US

IV. Provider business mailing address

13906 BRIARWOOD DR APT 2322
LAUREL MD
20708-1334
US

V. Phone/Fax

Practice location:
  • Phone: 240-564-7056
  • Fax:
Mailing address:
  • Phone: 240-564-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200001466
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: