Provider Demographics
NPI:1083273635
Name:NKWANUI, RAHIMATOU N/A
Entity type:Individual
Prefix:
First Name:RAHIMATOU
Middle Name:N/A
Last Name:NKWANUI
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 1:16 BANNINGTON DR UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1438
Mailing Address - Country:US
Mailing Address - Phone:202-660-8851
Mailing Address - Fax:
Practice Address - Street 1:16 BANNINGTON DR UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1438
Practice Address - Country:US
Practice Address - Phone:202-660-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13641103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN-250-73000896Medicaid