Provider Demographics
NPI:1053836866
Name:GBADA, PRUDENCIA AMELE
Entity Type:Individual
Prefix:
First Name:PRUDENCIA
Middle Name:AMELE
Last Name:GBADA
Suffix:
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 1:6323 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1101
Mailing Address - Country:US
Mailing Address - Phone:202-506-1242
Mailing Address - Fax:202-506-1396
Practice Address - Street 1:6323 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1101
Practice Address - Country:US
Practice Address - Phone:202-506-1242
Practice Address - Fax:202-506-1396
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA12911374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide