Provider Demographics
NPI:1457706848
Name:AWUNGATEH NTIWOH, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:AWUNGATEH NTIWOH
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 1:5807 CHERRYWOOD LN APT 202
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1296
Mailing Address - Country:US
Mailing Address - Phone:443-857-2209
Mailing Address - Fax:
Practice Address - Street 1:5807 CHERRYWOOD LN APT 202
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1296
Practice Address - Country:US
Practice Address - Phone:443-857-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide