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General NPI Number Information
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NPI Number | 1861013435
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Entity Type | Individual
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Provider Name | BERT-DESTINY TEKUM NGUFOR
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1818 NEW YORK AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1848
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Country | US
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Telephone | 202-489-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 75TH AVE APT 101
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City | HYATTSVILLE
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State | MD
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Zip | 20785-1914
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Country | US
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Telephone | 469-989-2082
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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