Provider Demographics
NPI:1568721157
Name:MBULIFAMG, ZIPPORA ANJEWAH
Entity Type:Individual
Prefix:MRS
First Name:ZIPPORA
Middle Name:ANJEWAH
Last Name:MBULIFAMG
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 1:6735 NEW HAMPSHIRE AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2819
Mailing Address - Country:US
Mailing Address - Phone:301-281-7416
Mailing Address - Fax:
Practice Address - Street 1:6735 NEW HAMPSHIRE AVE APT 201
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2819
Practice Address - Country:US
Practice Address - Phone:301-281-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM- 141982067701374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide