Provider Demographics
NPI:1972860773
Name:EMAIKWU, GRACE OWOLE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:OWOLE
Last Name:EMAIKWU
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 1:9201 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2703
Mailing Address - Country:US
Mailing Address - Phone:240-705-2040
Mailing Address - Fax:
Practice Address - Street 1:9201 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2703
Practice Address - Country:US
Practice Address - Phone:240-705-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE520288671812374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide