Provider Demographics
NPI:1558877092
Name:ASAA, OGEMDI MILLICENT (NP)
Entity Type:Individual
Prefix:
First Name:OGEMDI
Middle Name:MILLICENT
Last Name:ASAA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 BUTTERNUT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2419
Mailing Address - Country:US
Mailing Address - Phone:202-627-8407
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR
Practice Address - Street 2:STE 500 #1038
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:202-627-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227915163WP0808X, 363LP0808X
VA0001274378163WP0808X
DCNP1052490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health