Healthcare Provider Details

I. General information

NPI: 1063253698
Provider Name (Legal Business Name): HELMINE EGOKOM AGULABA AMBI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 SAINT JOSEPHS DR
BOWIE MD
20721-1889
US

IV. Provider business mailing address

2012 SAINT JOSEPHS DR
BOWIE MD
20721-1889
US

V. Phone/Fax

Practice location:
  • Phone: 240-909-0250
  • Fax:
Mailing address:
  • Phone: 240-909-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: