Healthcare Provider Details

I. General information

NPI: 1780125567
Provider Name (Legal Business Name): EDINA OBIZUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13907 LAKE MEADOWS
BOWIE MD
20720-3815
US

IV. Provider business mailing address

13907 LAKE MEADOWS DR
BOWIE MD
20720-3815
US

V. Phone/Fax

Practice location:
  • Phone: 301-633-3990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: