Provider Demographics
NPI:1326383480
Name:AKWENKWELLE, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:AKWENKWELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 QUEENS CHAPEL RD APT 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1168
Mailing Address - Country:US
Mailing Address - Phone:240-280-6077
Mailing Address - Fax:
Practice Address - Street 1:3139 QUEENS CHAPEL RD APT 202
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1168
Practice Address - Country:US
Practice Address - Phone:240-280-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide