Provider Demographics
NPI:1619581774
Name:NWUDE, OGOCHUKWU
Entity Type:Individual
Prefix:
First Name:OGOCHUKWU
Middle Name:
Last Name:NWUDE
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 1:11001 ROYAL GRANT CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2278
Mailing Address - Country:US
Mailing Address - Phone:240-481-5872
Mailing Address - Fax:
Practice Address - Street 1:11001 ROYAL GRANT CIR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2278
Practice Address - Country:US
Practice Address - Phone:240-481-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00153321Medicaid