Provider Demographics
NPI:1265271142
Name:AGUBUZO, ONYINYECHI DESTINY
Entity type:Individual
Prefix:
First Name:ONYINYECHI
Middle Name:DESTINY
Last Name:AGUBUZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ONYINYECHI
Other - Middle Name:DESTINY
Other - Last Name:AGUBUZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11010 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3809
Mailing Address - Country:US
Mailing Address - Phone:240-447-9090
Mailing Address - Fax:
Practice Address - Street 1:11010 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3809
Practice Address - Country:US
Practice Address - Phone:240-447-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02395374U00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide