Healthcare Provider Details

I. General information

NPI: 1083287486
Provider Name (Legal Business Name): NKEMKA UMUNNA-UDOH RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13009 GOLDEN OAK DR
LAUREL MD
20708-2331
US

IV. Provider business mailing address

13009 GOLDEN OAK DR
LAUREL MD
20708-2331
US

V. Phone/Fax

Practice location:
  • Phone: 202-315-8302
  • Fax:
Mailing address:
  • Phone: 202-315-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR5003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: