Provider Demographics
NPI:1124364658
Name:FRU, EMMANUEL NJI
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:NJI
Last Name:FRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 HARRY S TRUMAN DR APT 12
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2050
Mailing Address - Country:US
Mailing Address - Phone:240-667-6061
Mailing Address - Fax:
Practice Address - Street 1:257 HARRY S TRUMAN DR APT 12
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-2050
Practice Address - Country:US
Practice Address - Phone:240-667-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide