Provider Demographics
NPI:1346614070
Name:MOWJOODI, ONYEMAUWA
Entity Type:Individual
Prefix:
First Name:ONYEMAUWA
Middle Name:
Last Name:MOWJOODI
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:PO BOX 2552
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2552
Mailing Address - Country:US
Mailing Address - Phone:240-938-3917
Mailing Address - Fax:
Practice Address - Street 1:6823B RIVERDALE RD # B2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:240-938-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP46157164X00000X
DC1005331374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164X00000XNursing Service ProvidersLicensed Vocational Nurse