Provider Demographics
NPI:1568270528
Name:AJEWNSEH, EMMADEXTEL CHE
Entity type:Individual
Prefix:
First Name:EMMADEXTEL
Middle Name:CHE
Last Name:AJEWNSEH
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 1:10405 GRANDHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6626
Mailing Address - Country:US
Mailing Address - Phone:240-304-9476
Mailing Address - Fax:
Practice Address - Street 1:10405 GRANDHAVEN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6626
Practice Address - Country:US
Practice Address - Phone:240-304-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide