Provider Demographics
NPI:1083217251
Name:ATEKWANE, PHILOMENA
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:ATEKWANE
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 1:1900 ANNAWON CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1235
Mailing Address - Country:US
Mailing Address - Phone:240-906-4071
Mailing Address - Fax:
Practice Address - Street 1:1900 ANNAWON CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1235
Practice Address - Country:US
Practice Address - Phone:240-906-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA15239374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide