Provider Demographics
NPI:1992040109
Name:OWUNNAH NJEMANZE, LILLIAN
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:OWUNNAH NJEMANZE
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 1:12318 SHELTER LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2114
Mailing Address - Country:US
Mailing Address - Phone:240-494-6667
Mailing Address - Fax:
Practice Address - Street 1:12318 SHELTER LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2114
Practice Address - Country:US
Practice Address - Phone:240-494-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide