Provider Demographics
NPI:1467542209
Name:BAGUDU, LANRE (CHHA)
Entity Type:Individual
Prefix:
First Name:LANRE
Middle Name:
Last Name:BAGUDU
Suffix:
Gender:M
Credentials:CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RELER LN APT L
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3821
Mailing Address - Country:US
Mailing Address - Phone:732-407-3622
Mailing Address - Fax:
Practice Address - Street 1:2 RELER LN APT L
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3821
Practice Address - Country:US
Practice Address - Phone:732-407-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH08726200374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide