Provider Demographics
NPI:1831966308
Name:KODUA, JEMIMA FRIMPONG
Entity type:Individual
Prefix:
First Name:JEMIMA
Middle Name:FRIMPONG
Last Name:KODUA
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 1:1117 FUTURITY ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2358
Mailing Address - Country:US
Mailing Address - Phone:240-626-3286
Mailing Address - Fax:
Practice Address - Street 1:1117 FUTURITY ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2358
Practice Address - Country:US
Practice Address - Phone:240-626-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966950163W00000X
MD2023150880363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse