Provider Demographics
NPI:1639546708
Name:FORNUH FRU, JOHN SR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FORNUH FRU
Suffix:SR
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 1:7908 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2634
Mailing Address - Country:US
Mailing Address - Phone:301-655-0275
Mailing Address - Fax:
Practice Address - Street 1:7908 25TH AVE
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-2634
Practice Address - Country:US
Practice Address - Phone:301-655-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11348374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide