Provider Demographics
NPI:1891216305
Name:MUWUD, JASPER MBAH
Entity Type:Individual
Prefix:
First Name:JASPER
Middle Name:MBAH
Last Name:MUWUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JASPER
Other - Middle Name:MBAH
Other - Last Name:MUWUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HOME HEALTH AIDS
Mailing Address - Street 1:8623 ANNAPOLIS RD APT 102
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3106
Mailing Address - Country:US
Mailing Address - Phone:240-825-7954
Mailing Address - Fax:
Practice Address - Street 1:8623 ANNAPOLIS RD APT 102
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3106
Practice Address - Country:US
Practice Address - Phone:240-825-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12842374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide