Healthcare Provider Details

I. General information

NPI: 1033478029
Provider Name (Legal Business Name): ROSELYN NDIDIAMAKA UKAOBASI X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 LANDOVER RD
CHEVERLY MD
20785-1320
US

IV. Provider business mailing address

6023 SPRINGHILL DR APT 304
GREENBELT MD
20770-6117
US

V. Phone/Fax

Practice location:
  • Phone: 202-550-7742
  • Fax:
Mailing address:
  • Phone: 301-232-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberU212744612636
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA3590
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: