Provider Demographics
NPI:1457191215
Name:EBAMU, FELICIA FONKA
Entity type:Individual
Prefix:
First Name:FELICIA FONKA
Middle Name:
Last Name:EBAMU
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 1:7401 NEW HAMPSHIRE AVE APT 418
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6949
Mailing Address - Country:US
Mailing Address - Phone:240-991-7291
Mailing Address - Fax:
Practice Address - Street 1:7401 NEW HAMPSHIRE AVE APT 418
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6949
Practice Address - Country:US
Practice Address - Phone:240-991-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003729374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide