Healthcare Provider Details

I. General information

NPI: 1295385532
Provider Name (Legal Business Name): ALICE MFON UKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14023 CASTLE BLVD APT 401
SILVER SPRING MD
20904-4791
US

IV. Provider business mailing address

14023 CASTLE BLVD
SILVER SPRING MD
20904-4715
US

V. Phone/Fax

Practice location:
  • Phone: 240-305-5860
  • Fax:
Mailing address:
  • Phone: 240-305-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: