Healthcare Provider Details

I. General information

NPI: 1710363544
Provider Name (Legal Business Name): GANI NWAOGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EASTERN AVE NE
WASHINGTON DC
20019-2833
US

IV. Provider business mailing address

8150 LAKECREST DR
GREENBELT MD
20770-3334
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-1356
  • Fax:
Mailing address:
  • Phone: 240-280-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11409
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: