Healthcare Provider Details

I. General information

NPI: 1427620921
Provider Name (Legal Business Name): VIVIAN U OBIDIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

9500 ANNAPOLIS RD # SITEA5
LANHAM MD
20706-2060
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 240-413-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA15872
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: