MEDICARE: DIVINE NZEFEH EFFUTNGU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA200005825	DC

General Provider Information

NPI Number	:	1033073366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVINE NZEFEH EFFUTNGU

Provider Business Mailing Address
First Line	:	7509 TAYLOR ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-6319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7509 TAYLOR ST
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-6319
Country	:	US
Telephone Number	:	202-948-8431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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