Healthcare Provider Details

I. General information

NPI: 1265903603
Provider Name (Legal Business Name): REBECCA EFENGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11661 LOCKWOOD DR APT 204
SILVER SPRING MD
20904-2356
US

IV. Provider business mailing address

11661 LOCKWOOD DR APT 204
SILVER SPRING MD
20904-2356
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-0720
  • Fax:
Mailing address:
  • Phone: 240-821-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14166
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: