Provider Demographics
NPI:1871133975
Name:KODUAH, DORIS
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:KODUAH
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 1:8501 SHIRLEY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1348
Mailing Address - Country:US
Mailing Address - Phone:571-245-6953
Mailing Address - Fax:
Practice Address - Street 1:8501 SHIRLEY WOODS CT
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1348
Practice Address - Country:US
Practice Address - Phone:571-245-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health