Provider Demographics
NPI:1922405794
Name:FON, CLAUDETTE
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:FON
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 1:11327 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-1316
Mailing Address - Country:US
Mailing Address - Phone:240-614-1865
Mailing Address - Fax:240-654-5599
Practice Address - Street 1:11327 STEVENSON DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-1316
Practice Address - Country:US
Practice Address - Phone:240-614-1865
Practice Address - Fax:240-654-5599
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-22
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC11236374U00000X
DCNA00606318376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1922405794Medicaid