Provider Demographics
NPI:1881932374
Name:SAMA EPSE FOGWE, LILIAN MANYI (HHA)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:MANYI
Last Name:SAMA EPSE FOGWE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 GEORGIA AVE, SUITE 323
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012
Mailing Address - Country:US
Mailing Address - Phone:202-723-3060
Mailing Address - Fax:202-723-3065
Practice Address - Street 1:2218 BRIGHTSEAT RD
Practice Address - Street 2:APT 201
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-3514
Practice Address - Country:US
Practice Address - Phone:240-413-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCLPN1008520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide