Provider Demographics
NPI:1003412040
Name:SAWADOGO, MAHAMADI (RN,BSN,WCC)
Entity Type:Individual
Prefix:
First Name:MAHAMADI
Middle Name:
Last Name:SAWADOGO
Suffix:
Gender:M
Credentials:RN,BSN,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 LANCASTER CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4681
Mailing Address - Country:US
Mailing Address - Phone:202-290-5123
Mailing Address - Fax:
Practice Address - Street 1:4132 LANCASTER CIR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4681
Practice Address - Country:US
Practice Address - Phone:202-290-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR245520163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD85-3995016OtherIRS