MEDICARE: FELICIA WIRNGO DZEKASHU BIRUN

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	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1336408178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA WIRNGO DZEKASHU BIRUN

Provider Business Mailing Address
First Line	:	9879 GOOD LUCK RD
Second Line	:	APT3
City	:	LANHAM
State	:	MD
Zip	:	20706-3213
Country	:	US
Telephone Number	:	301-323-3392
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5614
Country	:	US
Telephone Number	:	202-836-4841
Fax Number	:	202-836-4842

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

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	10/01/2024

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