Provider Demographics
NPI:1225571979
Name:KPAKA, ROSEMARIE MARIATU
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:MARIATU
Last Name:KPAKA
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 1:7203 ADELPHI RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1004
Mailing Address - Country:US
Mailing Address - Phone:240-495-4981
Mailing Address - Fax:
Practice Address - Street 1:7203 ADELPHI RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1004
Practice Address - Country:US
Practice Address - Phone:240-495-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12506374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111302534Medicaid