MEDICARE: INI UDOH

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	NA00603449	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA00603449	OTHER	DC	CERTIFIED NURSING ASSISTANT

General Provider Information

NPI Number	:	1710438452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INI UDOH

Provider Business Mailing Address
First Line	:	3522 54TH AVE
Second Line	:	APT. #1
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1004
Country	:	US
Telephone Number	:	202-378-0957
Fax Number	:

Provider Business Practice Location Address
First Line	:	3522 54TH AVE
Second Line	:	APT. #1
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1004
Country	:	US
Telephone Number	:	202-378-0957
Fax Number	:

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

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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Directions to “ INI UDOH ” Practice Location

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