Provider Demographics
NPI:1477918274
Name:EGBUCHERE, CHISOM ADANNA
Entity Type:Individual
Prefix:
First Name:CHISOM
Middle Name:ADANNA
Last Name:EGBUCHERE
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 1:1009 CHILLUM RD
Mailing Address - Street 2:208
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2265
Mailing Address - Country:US
Mailing Address - Phone:301-543-9879
Mailing Address - Fax:
Practice Address - Street 1:1009 CHILLUM RD
Practice Address - Street 2:208
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2265
Practice Address - Country:US
Practice Address - Phone:301-543-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11682374U00000X
DCNA00607511376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA11682OtherHHA LICENSE
DCNA00607511OtherCNA LICENSE