Provider Demographics
NPI:1629422381
Name:AWAH, MAGDALENE
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:
Last Name:AWAH
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 1:8066 WINDWARD KEY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3119
Mailing Address - Country:US
Mailing Address - Phone:301-385-1796
Mailing Address - Fax:
Practice Address - Street 1:8066 WINDWARD KEY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3119
Practice Address - Country:US
Practice Address - Phone:301-385-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11635374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide