Provider Demographics
NPI:1235975574
Name:AGUGUO, KELECHI PEACE
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:PEACE
Last Name:AGUGUO
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 1:7512 KELSEYS LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3709
Mailing Address - Country:US
Mailing Address - Phone:443-791-0678
Mailing Address - Fax:
Practice Address - Street 1:5884 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2612
Practice Address - Country:US
Practice Address - Phone:443-791-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203174163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health