Healthcare Provider Details

I. General information

NPI: 1467712885
Provider Name (Legal Business Name): RUTH OGUNSUYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15606 N PLATTE DR
BOWIE MD
20716-1361
US

IV. Provider business mailing address

15606 N PLATTE DR
BOWIE MD
20716-1361
US

V. Phone/Fax

Practice location:
  • Phone: 240-264-0138
  • Fax:
Mailing address:
  • Phone: 240-264-0138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberO-252-751-031-415
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: