Healthcare Provider Details

I. General information

NPI: 1578818852
Provider Name (Legal Business Name): MS. JOSEPHINE ONYEISI UDIENU CHIEDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE G35
WASHINGTON DC
20003-3738
US

IV. Provider business mailing address

3201 75TH AVE APT 203
LANDOVER MD
20785-1942
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8090
  • Fax: 202-544-8091
Mailing address:
  • Phone: 240-539-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA4151
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: