Provider Demographics
NPI:1417463654
Name:NGULEFEH, KODIA
Entity Type:Individual
Prefix:
First Name:KODIA
Middle Name:
Last Name:NGULEFEH
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 1:13809 BRIARWOOD DR APT 1533
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1346
Mailing Address - Country:US
Mailing Address - Phone:240-486-6724
Mailing Address - Fax:
Practice Address - Street 1:13809 BRIARWOOD DR APT 1533
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1346
Practice Address - Country:US
Practice Address - Phone:240-486-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13336374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide