Healthcare Provider Details

I. General information

NPI: 1366707374
Provider Name (Legal Business Name): KUDIRAT OGUNFOWOKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

IV. Provider business mailing address

3426 DODGE PARK RD
LANDOVER MD
20785-2051
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-6973
  • Fax:
Mailing address:
  • Phone: 202-725-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: