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Individual

LIVET ECHICK MUKUM FONGANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4506 WOODGATE WAY, BOWIE, MD 20720-3449
(240) 714-8332
Mailing address
4506 WOODGATE WAY, BOWIE, MD 20720-3449
(240) 714-8332

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA12593
DC

Other

Enumeration date
06/13/2017
Last updated
03/30/2018
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