Healthcare Provider Details

I. General information

NPI: 1790180586
Provider Name (Legal Business Name): AKOBUCHI UDOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 58TH AVE
RIVERDALE MD
20737-3202
US

IV. Provider business mailing address

5208 58TH AVE
RIVERDALE MD
20737-3202
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-0091
  • Fax:
Mailing address:
  • Phone: 301-277-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA2049
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00020742
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA00600061
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: