Provider Demographics
NPI:1609204098
Name:ADANGWA, PROSPER JONI
Entity type:Individual
Prefix:
First Name:PROSPER
Middle Name:JONI
Last Name:ADANGWA
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 1:9863 GOOD LUCK RD APT 12
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3225
Mailing Address - Country:US
Mailing Address - Phone:240-778-4615
Mailing Address - Fax:301-982-6488
Practice Address - Street 1:9863 GOOD LUCK RD APT 12
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3225
Practice Address - Country:US
Practice Address - Phone:240-778-4615
Practice Address - Fax:301-982-6488
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide