MEDICARE: ERNESTINE N FONGO EPSE NAOUSSI

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	HHA200001366	DC

General Provider Information

NPI Number	:	1295407674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTINE N FONGO EPSE NAOUSSI

Provider Business Mailing Address
First Line	:	2100 BELVEDERE BLVD APT 6
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5625
Country	:	US
Telephone Number	:	202-291-6973
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 BELVEDERE BLVD APT 6
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-5625
Country	:	US
Telephone Number	:	301-326-9531
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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