Healthcare Provider Details

I. General information

NPI: 1609204098
Provider Name (Legal Business Name): PROSPER JONI ADANGWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9863 GOOD LUCK RD APT 12
LANHAM MD
20706-3225
US

IV. Provider business mailing address

9863 GOOD LUCK RD APT 12
LANHAM MD
20706-3225
US

V. Phone/Fax

Practice location:
  • Phone: 240-778-4615
  • Fax: 301-982-6488
Mailing address:
  • Phone: 240-778-4615
  • Fax: 301-982-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: