Provider Demographics
NPI:1194108472
Name:MADUAKO, EZINNA
Entity type:Individual
Prefix:
First Name:EZINNA
Middle Name:
Last Name:MADUAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7913 MANDAN RD
Mailing Address - Street 2:APT. 204
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2819
Mailing Address - Country:US
Mailing Address - Phone:202-766-6386
Mailing Address - Fax:
Practice Address - Street 1:7913 MANDAN RD
Practice Address - Street 2:APT. 204
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2819
Practice Address - Country:US
Practice Address - Phone:202-766-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11367374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDHHA11367OtherDOH