Provider Demographics
NPI:1538689765
Name:WELKO NJEONWOUO EPSE AYI GEH, CHAMBERLINE
Entity Type:Individual
Prefix:
First Name:CHAMBERLINE
Middle Name:
Last Name:WELKO NJEONWOUO EPSE AYI GEH
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 1:9146 EDMONSTON RD APT 202
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4389
Mailing Address - Country:US
Mailing Address - Phone:240-825-7965
Mailing Address - Fax:
Practice Address - Street 1:9146 EDMONSTON RD APT 202
Practice Address - Street 2:202
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:240-825-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HHA12827374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide