Provider Demographics
NPI:1336408178
Name:BIRUN, FELICIA WIRNGO DZEKASHU
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:WIRNGO DZEKASHU
Last Name:BIRUN
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 1:9879 GOOD LUCK RD
Mailing Address - Street 2:APT3
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3213
Mailing Address - Country:US
Mailing Address - Phone:301-323-3392
Mailing Address - Fax:
Practice Address - Street 1:1427 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5614
Practice Address - Country:US
Practice Address - Phone:202-836-4841
Practice Address - Fax:202-836-4842
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide