Provider Demographics
NPI:1770961708
Name:EGBOGU, NKECHI
Entity type:Individual
Prefix:
First Name:NKECHI
Middle Name:
Last Name:EGBOGU
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 1:721 48TH ST NE # EAST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3607
Mailing Address - Country:US
Mailing Address - Phone:202-541-9844
Mailing Address - Fax:202-541-9845
Practice Address - Street 1:5620 FISHERMENS CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1572
Practice Address - Country:US
Practice Address - Phone:443-707-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11198374U00000X
DCRN500007851163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide