Provider Demographics
NPI:1942718572
Name:UGOMMA, BEATRICE AZU
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:AZU
Last Name:UGOMMA
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 1:6010 LOGAN WAY APT C3
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1892
Mailing Address - Country:US
Mailing Address - Phone:202-910-5977
Mailing Address - Fax:
Practice Address - Street 1:6010 LOGAN WAY APT C3
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1892
Practice Address - Country:US
Practice Address - Phone:202-910-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA13422374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide