Individual
MRS. ELIZABETH FORMUKONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2759 MARTIN LUTHER KING JR AVE SE, WASHINGTON, DC 20032-2646
(202) 827-9961
(202) 827-9963
Mailing address
1510 MISSISSIPPI AVE SE, WASHINGTON, DC 20032-4431
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
374U00000X
Home Health Aide
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70931318
—
DC
Enumeration date
10/10/2020
Last updated
02/14/2025
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