Provider Demographics
NPI:1184180549
Name:NDULA, DIVINA NCHUFOA
Entity Type:Individual
Prefix:
First Name:DIVINA NCHUFOA
Middle Name:
Last Name:NDULA
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 1:10704 LAKE ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3137
Mailing Address - Country:US
Mailing Address - Phone:240-521-8147
Mailing Address - Fax:
Practice Address - Street 1:7843 RIVERDALE RD APT T3
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4025
Practice Address - Country:US
Practice Address - Phone:240-521-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14280374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide