Healthcare Provider Details

I. General information

NPI: 1558969709
Provider Name (Legal Business Name): OBINNA MOJEKWU OHAERI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 E ST SE APT 101
WASHINGTON DC
20019-6072
US

IV. Provider business mailing address

5312 E ST SE APT 101
WASHINGTON DC
20019-6072
US

V. Phone/Fax

Practice location:
  • Phone: 240-713-1962
  • Fax:
Mailing address:
  • Phone: 240-713-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14535
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: