Individual
PRUDENCIA ESAMAKA BANENI EPSE DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 12TH ST NW, WASHINGTON, DC 20005-4602
(202) 813-3421
Mailing address
6606 RYCROFT AVE, NEW CARROLLTON, MD 20784-3652
(240) 886-5599
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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