Provider Demographics
NPI:1033478029
Name:UKAOBASI, ROSELYN NDIDIAMAKA X
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:NDIDIAMAKA
Last Name:UKAOBASI
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 SPRINGHILL DR APT 304
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-6117
Mailing Address - Country:US
Mailing Address - Phone:301-232-6528
Mailing Address - Fax:
Practice Address - Street 1:6319 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1320
Practice Address - Country:US
Practice Address - Phone:202-550-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU212744612636376K00000X
DCHHA3590374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide