Provider Demographics
NPI:1609605930
Name:AMENDAM EPSE ASHU, JESSIE SABUM
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:SABUM
Last Name:AMENDAM EPSE ASHU
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 1:6523 DAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3555
Mailing Address - Country:US
Mailing Address - Phone:301-254-4212
Mailing Address - Fax:
Practice Address - Street 1:6523 DAWNWOOD DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3555
Practice Address - Country:US
Practice Address - Phone:301-254-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide