Provider Demographics
NPI:1437665098
Name:EWOH NDU, MARIE CLAIRE
Entity Type:Individual
Prefix:
First Name:MARIE CLAIRE
Middle Name:
Last Name:EWOH NDU
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 1:2320 BROOKE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1859
Mailing Address - Country:US
Mailing Address - Phone:240-548-8100
Mailing Address - Fax:
Practice Address - Street 1:2320 BROOKE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1859
Practice Address - Country:US
Practice Address - Phone:240-548-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13355374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13355Medicaid