Provider Demographics
NPI:1851641997
Name:IDEHEN, BRIGHT OSAREMEN
Entity Type:Individual
Prefix:
First Name:BRIGHT
Middle Name:OSAREMEN
Last Name:IDEHEN
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 1:10081 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2103
Mailing Address - Country:US
Mailing Address - Phone:202-717-1037
Mailing Address - Fax:
Practice Address - Street 1:10081 CAMPUS WAY S
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2103
Practice Address - Country:US
Practice Address - Phone:202-717-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide