Provider Demographics
NPI:1194191999
Name:AKWESEH, MISPA
Entity Type:Individual
Prefix:
First Name:MISPA
Middle Name:
Last Name:AKWESEH
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 1:7920 18TH AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4534
Mailing Address - Country:US
Mailing Address - Phone:240-643-0280
Mailing Address - Fax:
Practice Address - Street 1:7920 18TH AVE
Practice Address - Street 2:APT 210
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4534
Practice Address - Country:US
Practice Address - Phone:240-643-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA11448374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide