Provider Demographics
NPI:1003132085
Name:MWAKINGWE, AGNES
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:MWAKINGWE
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 1:2 FLANDERS CT
Mailing Address - Street 2:APT K
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5151
Mailing Address - Country:US
Mailing Address - Phone:917-748-2589
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2780
Practice Address - Country:US
Practice Address - Phone:410-550-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program