Provider Demographics
NPI:1346755626
Name:ABONO, JUNIOR NDUBI
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:NDUBI
Last Name:ABONO
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 1:1085 CATESBY TER
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5990
Mailing Address - Country:US
Mailing Address - Phone:240-486-5361
Mailing Address - Fax:
Practice Address - Street 1:1085 CATESBY TER
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5990
Practice Address - Country:US
Practice Address - Phone:240-486-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13247374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide