Provider Demographics
NPI:1578105227
Name:FONKENG, BENARD N (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MR
First Name:BENARD
Middle Name:N
Last Name:FONKENG
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 EDGEWOOD ST NE APT 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3328
Mailing Address - Country:US
Mailing Address - Phone:240-615-9721
Mailing Address - Fax:
Practice Address - Street 1:401 EDGEWOOD ST NE APT 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3328
Practice Address - Country:US
Practice Address - Phone:240-615-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHH14642374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide