Provider Demographics
NPI:1467908079
Name:FRU, ELIZABETH AFAASEH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AFAASEH
Last Name:FRU
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 1:3527 LESLIE WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2115
Mailing Address - Country:US
Mailing Address - Phone:240-444-9265
Mailing Address - Fax:
Practice Address - Street 1:3527 LESLIE WAY APT 3
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724
Practice Address - Country:US
Practice Address - Phone:240-444-9265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12278374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide