Provider Demographics
NPI:1912372483
Name:MFORMEN, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MFORMEN
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 1:46860 HILTON DR APT 1131
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3730
Mailing Address - Country:US
Mailing Address - Phone:202-378-0513
Mailing Address - Fax:
Practice Address - Street 1:46860 HILTON DR APT 1131
Practice Address - Street 2:
Practice Address - City:LEXINGTON PK
Practice Address - State:MD
Practice Address - Zip Code:20653-3730
Practice Address - Country:US
Practice Address - Phone:202-378-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11702374U00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA11702OtherHOME HEALTH AIDE