Healthcare Provider Details

I. General information

NPI: 1447077805
Provider Name (Legal Business Name): GIFTER N BUNGWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 ROBERT LEWIS AVE
UPPER MARLBORO MD
20774-5689
US

IV. Provider business mailing address

1405 ROBERT LEWIS AVE
UPPER MARLBORO MD
20774-5689
US

V. Phone/Fax

Practice location:
  • Phone: 410-725-1146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: