Provider Demographics
NPI:1316419054
Name:ABOSI, EDWIN AMBE
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:AMBE
Last Name:ABOSI
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 1:4223 58TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1945
Mailing Address - Country:US
Mailing Address - Phone:612-232-8863
Mailing Address - Fax:
Practice Address - Street 1:4223 58TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1945
Practice Address - Country:US
Practice Address - Phone:612-232-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14193374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide