Provider Demographics
NPI:1851788673
Name:ONWUCHURUBAU, KINGSLEY U
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:U
Last Name:ONWUCHURUBAU
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 1:6654 SNBBERY COURT 12124
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:12124
Mailing Address - Country:US
Mailing Address - Phone:144-355-0392
Mailing Address - Fax:
Practice Address - Street 1:6654 SNBBERY COURT 12124
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:12124
Practice Address - Country:US
Practice Address - Phone:144-355-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11137163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health