Provider Demographics
NPI:1659840460
Name:AYUK, FNU OBEN AGNES
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:OBEN AGNES
Last Name:AYUK
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 1:9201 BLUEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5428
Mailing Address - Country:US
Mailing Address - Phone:240-714-9744
Mailing Address - Fax:
Practice Address - Street 1:9201 BLUEFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-5428
Practice Address - Country:US
Practice Address - Phone:240-714-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14150374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide