Healthcare Provider Details

I. General information

NPI: 1225392129
Provider Name (Legal Business Name): CHARECE NDUKUBA HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 GEATON PARK PL
LANHAM MD
20706-2682
US

IV. Provider business mailing address

9318 GEATON PARK PL
LANHAM MD
20706-2682
US

V. Phone/Fax

Practice location:
  • Phone: 260-604-2602
  • Fax: 202-545-0934
Mailing address:
  • Phone: 240-604-2502
  • Fax: 202-545-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: