Provider Demographics
NPI:1245887116
Name:MADUBUKO, JENNIFER CHINYERE (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CHINYERE
Last Name:MADUBUKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 OLD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4616
Mailing Address - Country:US
Mailing Address - Phone:240-334-1121
Mailing Address - Fax:
Practice Address - Street 1:12902 OLD CHAPEL RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4616
Practice Address - Country:US
Practice Address - Phone:240-334-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4422251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health