Most Relevant Information
Provider Data
| NPI Number: | 1003458969 |
| Provider Name: | SULLIZ NKWOMBOH EDEITY |
| Entity Type: | Individual |
| Taxonomy Code: | 374U00000X |
| Specialty: | Home Health Aide |
| License Number: | HHA14419 |
Most Important Dates
| Enumeration Date: | 10/11/2019 |
| Last Updated: | 10/11/2019 |
Provider Practice Location
845 21ST ST NE
WASHINGTON
DC
200024168
Practice Location Phone/Fax
| Phone: | 2404867890 |
| Fax: |
Provider Mailing Location
2320 BROOKE GROVE RD
BOWIE
MD
207211859
Provider Mailing Phone/Fax
| Phone: | 2405488100 |
| Fax: |