MEDICARE: ROSELYN NDIDIAMAKA UKAOBASI X

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	U212744612636	MD
2	374U00000X	Home Health Aide	HHA3590	DC

General Provider Information

NPI Number	:	1033478029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELYN NDIDIAMAKA UKAOBASI X

Provider Business Mailing Address
First Line	:	6023 SPRINGHILL DR APT 304
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-6117
Country	:	US
Telephone Number	:	301-232-6528
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319 LANDOVER RD
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1320
Country	:	US
Telephone Number	:	202-550-7742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	03/01/2018

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