Provider Demographics
NPI:1134481179
Name:AGBAKWURU, ROSE NGOZI
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:NGOZI
Last Name:AGBAKWURU
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 1:9548 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4010
Mailing Address - Country:US
Mailing Address - Phone:240-413-2479
Mailing Address - Fax:
Practice Address - Street 1:9548 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4010
Practice Address - Country:US
Practice Address - Phone:240-413-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA212744628562374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide