Provider Demographics
NPI:1659647816
Name:UKUM MEMBA, GWENDOLINE NEGEBAH (HHA)
Entity Type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:NEGEBAH
Last Name:UKUM MEMBA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 SHANNAN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2450
Mailing Address - Country:US
Mailing Address - Phone:024-591-7222
Mailing Address - Fax:
Practice Address - Street 1:302 CHERRYWOOD TER
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-454-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide