Provider Demographics
NPI:1366159147
Name:FONBAH ANGWAFRI, CHANEL
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:FONBAH ANGWAFRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5953
Mailing Address - Country:US
Mailing Address - Phone:240-645-3986
Mailing Address - Fax:
Practice Address - Street 1:7600 GEORGIA AVE NW STE 316
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1639
Practice Address - Country:US
Practice Address - Phone:202-500-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA20002199374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide