MEDICARE: RUTH TIFUH FOMUKOM EPSE FOMENYEN

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

General Provider Information

NPI Number	:	1043073505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH TIFUH FOMUKOM EPSE FOMENYEN

Provider Business Mailing Address
First Line	:	7847 RIVERDALE RD
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4008
Country	:	US
Telephone Number	:	240-505-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	7847 RIVERDALE RD
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4008
Country	:	US
Telephone Number	:	240-505-9614
Fax Number	:

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

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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Directions to “ RUTH TIFUH FOMUKOM EPSE FOMENYEN ” Practice Location

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