Provider Demographics
NPI:1912453630
Name:GNAGNIKO, AMELE AKOFA
Entity Type:Individual
Prefix:
First Name:AMELE
Middle Name:AKOFA
Last Name:GNAGNIKO
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 1:1018 QUEBEC TER
Mailing Address - Street 2:APT 101
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3156
Mailing Address - Country:US
Mailing Address - Phone:240-423-6562
Mailing Address - Fax:
Practice Address - Street 1:1018 QUEBEC TER
Practice Address - Street 2:APT 101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3156
Practice Address - Country:US
Practice Address - Phone:240-423-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12268390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program