Provider Demographics
NPI:1063928265
Name:FRANKLINE EKESAGHA FOTABE, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:FRANKLINE EKESAGHA FOTABE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 QUEENS CHAPEL RD APT 207
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3632
Mailing Address - Country:US
Mailing Address - Phone:240-615-7239
Mailing Address - Fax:
Practice Address - Street 1:2400 QUEENS CHAPEL RD APT 207
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3632
Practice Address - Country:US
Practice Address - Phone:240-615-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13383374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide