Individual
MRS. GRACE UDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13927 WESTVIEW FOREST DR, BOWIE, MD 20720-4866
(301) 789-1006
Mailing address
13927 WESTVIEW FOREST DR, BOWIE, MD 20720-4866
(301) 789-1006
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN961787
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-3767580
TAX ID#27-3767580
—
Enumeration date
11/17/2011
Last updated
11/17/2011
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