Provider Demographics
NPI:1659825537
Name:SUSAN, ACHUO AGBOR
Entity Type:Individual
Prefix:
First Name:ACHUO
Middle Name:AGBOR
Last Name:SUSAN
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 1:5902 31ST AVE APT 615
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2911
Mailing Address - Country:US
Mailing Address - Phone:301-237-8453
Mailing Address - Fax:
Practice Address - Street 1:5902 31ST AVE APT 615
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2911
Practice Address - Country:US
Practice Address - Phone:301-237-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12244374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide