Healthcare Provider Details

I. General information

NPI: 1326963612
Provider Name (Legal Business Name): FON JULIETTE ETANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823C RIVERDALE RD APT 201C
RIVERDALE MD
20737-1884
US

IV. Provider business mailing address

6823C RIVERDALE RD APT 201C
RIVERDALE MD
20737-1884
US

V. Phone/Fax

Practice location:
  • Phone: 971-381-0713
  • Fax:
Mailing address:
  • Phone: 971-381-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: