Provider Demographics
NPI:1336400696
Name:GBENOBA-NWANETI, NGOZI
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:
Last Name:GBENOBA-NWANETI
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 1:9865 GOOD LUCK RD
Mailing Address - Street 2:APT 7
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3203
Mailing Address - Country:US
Mailing Address - Phone:301-273-8318
Mailing Address - Fax:
Practice Address - Street 1:9865 GOOD LUCK RD
Practice Address - Street 2:APT 7
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3203
Practice Address - Country:US
Practice Address - Phone:301-273-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide