Provider Demographics
NPI:1720315997
Name:NWAGBO, CORDELIA ADA
Entity Type:Individual
Prefix:MS
First Name:CORDELIA
Middle Name:ADA
Last Name:NWAGBO
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 1:11540 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9469
Mailing Address - Country:US
Mailing Address - Phone:301-768-6060
Mailing Address - Fax:301-358-3883
Practice Address - Street 1:11540 PROSPECT HILL RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9469
Practice Address - Country:US
Practice Address - Phone:301-768-6060
Practice Address - Fax:301-358-3883
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2809P251E00000X
MD0803001251J00000X
MD080401253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care