Provider Demographics
NPI:1376802314
Name:ADE, BEULAH E
Entity type:Individual
Prefix:
First Name:BEULAH
Middle Name:E
Last Name:ADE
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 1:15008 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3088
Mailing Address - Country:US
Mailing Address - Phone:240-486-9099
Mailing Address - Fax:
Practice Address - Street 1:9600 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3724
Practice Address - Country:US
Practice Address - Phone:240-486-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA330085161517374U00000X
DCRN1041070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide