Provider Demographics
NPI:1912590100
Name:ABENGOWE, CHRISTIANA
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:ABENGOWE
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 1:605 HUDSON AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6271
Mailing Address - Country:US
Mailing Address - Phone:240-468-9716
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:605 HUDSON AVE APT 113
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6271
Practice Address - Country:US
Practice Address - Phone:240-468-9716
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP40732164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse