Basic Information
Provider Information
NPI: 1326669706
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKU
FirstName: ESA
MiddleName: SAPHERINE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 901 NICHOLS DR UNIT 201
Address2:  
City: LAUREL
State: MD
PostalCode: 207073586
CountryCode: US
TelephoneNumber: 2405649413
FaxNumber:  
Practice Location
Address1: 2512 24TH ST NE
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200182126
CountryCode: US
TelephoneNumber: 2028328340
FaxNumber: 2028328341
Other Information
ProviderEnumerationDate: 04/27/2020
LastUpdateDate: 04/27/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/27/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374U00000XHHA15234DCY Nursing Service Related ProvidersHome Health Aide 

No ID Information.


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