Provider Demographics
NPI:1578825139
Name:AKOM, BRENDA A
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:AKOM
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 1:4601 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1028
Mailing Address - Country:US
Mailing Address - Phone:240-481-1699
Mailing Address - Fax:
Practice Address - Street 1:4601 E WEST HWY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1028
Practice Address - Country:US
Practice Address - Phone:240-481-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide