Provider Demographics
NPI:1699170977
Name:NDI, JACQUELINE AZOH (LPN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:AZOH
Last Name:NDI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 WOOD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2111
Mailing Address - Country:US
Mailing Address - Phone:301-437-7443
Mailing Address - Fax:
Practice Address - Street 1:6407 WOOD POINTE DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2111
Practice Address - Country:US
Practice Address - Phone:301-437-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1003953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse