Healthcare Provider Details

I. General information

NPI: 1043146640
Provider Name (Legal Business Name): NGWON EUNICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 RED LEAF CT
UPPER MARLBORO MD
20774-1325
US

IV. Provider business mailing address

402 RED LEAF CT
UPPER MARLBORO MD
20774-1325
US

V. Phone/Fax

Practice location:
  • Phone: 240-940-9538
  • Fax:
Mailing address:
  • Phone: 240-940-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006348
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: