Basic Information
| Provider Information | |||||||||
| NPI: | 1831561703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NDUKWE | ||||||||
| FirstName: | OLUEBUBE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6938 DECATUR ST | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207841547 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6556 EASTERN AVENUE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025456980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2015 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | HHA9486 | DC | Y | Nursing Service Related Providers | Home Health Aide |
No ID Information.