Provider Demographics
NPI:1710438452
Name:UDOH, INI
Entity Type:Individual
Prefix:
First Name:INI
Middle Name:
Last Name:UDOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 54TH AVE
Mailing Address - Street 2:APT. #1
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1004
Mailing Address - Country:US
Mailing Address - Phone:202-378-0957
Mailing Address - Fax:
Practice Address - Street 1:3522 54TH AVE
Practice Address - Street 2:APT. #1
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1004
Practice Address - Country:US
Practice Address - Phone:202-378-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00603449376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNA00603449OtherCERTIFIED NURSING ASSISTANT