Provider Demographics
NPI:1699378281
Name:EMILIA, ANGWI TAH
Entity Type:Individual
Prefix:
First Name:ANGWI
Middle Name:TAH
Last Name:EMILIA
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 1:9733 COUNTRY MEADOWS LN APT 1A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6306
Mailing Address - Country:US
Mailing Address - Phone:443-985-4096
Mailing Address - Fax:
Practice Address - Street 1:9733 COUNTRY MEADOWS LN APT 1A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6306
Practice Address - Country:US
Practice Address - Phone:443-985-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00187625376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide