MEDICARE: DANIEL AWA FONJUNGO RN

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	163W00000X	Registered Nurse	809827	TX

General Provider Information

NPI Number	:	1619833068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL AWA FONJUNGO RN

Provider Business Mailing Address
First Line	:	26 GREENWOOD CT
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2047
Country	:	US
Telephone Number	:	410-329-0558
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 GREENWOOD CT
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2047
Country	:	US
Telephone Number	:	410-329-0558
Fax Number	:

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

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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