Provider Demographics
NPI:1649748278
Name:OGUDO, ANTHONETTE EZINNE
Entity Type:Individual
Prefix:
First Name:ANTHONETTE
Middle Name:EZINNE
Last Name:OGUDO
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 1:9801 GOOD LUCK RD APT 12
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3352
Mailing Address - Country:US
Mailing Address - Phone:202-779-8514
Mailing Address - Fax:
Practice Address - Street 1:9801 GOOD LUCK RD APT 12
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3352
Practice Address - Country:US
Practice Address - Phone:202-779-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14143374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide