Provider Demographics
NPI:1598119455
Name:FORKWA, ODETTE ENGWALI I
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:ENGWALI
Last Name:FORKWA
Suffix:I
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 1:4083 WARNER AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1943
Mailing Address - Country:US
Mailing Address - Phone:240-467-6096
Mailing Address - Fax:
Practice Address - Street 1:4083 WARNER AVE APT C2
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1943
Practice Address - Country:US
Practice Address - Phone:240-467-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
DCHHA11957374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide