Healthcare Provider Details

I. General information

NPI: 1356981344
Provider Name (Legal Business Name): LADI TIKU FRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 BROOKE GROVE RD
BOWIE MD
20721-1885
US

IV. Provider business mailing address

2508 BROOKE GROVE RD
BOWIE MD
20721-1885
US

V. Phone/Fax

Practice location:
  • Phone: 651-447-0757
  • Fax:
Mailing address:
  • Phone: 651-447-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: