Provider Demographics
NPI:1184001323
Name:PEGHA EPSE ETAMO, PATIENCE MANYIFED
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MANYIFED
Last Name:PEGHA EPSE ETAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 LANDOVER RD APT 104
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1341
Mailing Address - Country:US
Mailing Address - Phone:240-716-9523
Mailing Address - Fax:
Practice Address - Street 1:6341 LANDOVER RD APT 104
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1341
Practice Address - Country:US
Practice Address - Phone:240-360-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11259374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide