Provider Demographics
NPI:1972379626
Name:BADU-PRAH, MAGDALENE
Entity type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:
Last Name:BADU-PRAH
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 1:15863 AERIAL VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5894
Mailing Address - Country:US
Mailing Address - Phone:571-405-9198
Mailing Address - Fax:
Practice Address - Street 1:14714 BROOK DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1348
Practice Address - Country:US
Practice Address - Phone:571-405-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001286387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse