Provider Demographics
NPI:1912265976
Name:FONJI, MIRABEL ANGUM (HHA)
Entity Type:Individual
Prefix:MISS
First Name:MIRABEL
Middle Name:ANGUM
Last Name:FONJI
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 1:3320 TOLEDO TER APT P5
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4153
Mailing Address - Country:US
Mailing Address - Phone:240-501-5142
Mailing Address - Fax:
Practice Address - Street 1:3320 TOLEDO TER APT P5
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4153
Practice Address - Country:US
Practice Address - Phone:240-501-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide