Provider Demographics
NPI:1982033783
Name:ONUKWUGHA, IKENNA SR
Entity Type:Individual
Prefix:
First Name:IKENNA
Middle Name:
Last Name:ONUKWUGHA
Suffix:SR
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 1:7833 RIVERDALE RD APT T3
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4017
Mailing Address - Country:US
Mailing Address - Phone:301-828-8747
Mailing Address - Fax:
Practice Address - Street 1:7833 RIVERDALE RD APT T3
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4017
Practice Address - Country:US
Practice Address - Phone:301-828-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9388374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide