Provider Demographics
NPI:1942010103
Name:AGWA, RACHEL (RN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:AGWA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:OMEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:7964 JASONS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2664
Mailing Address - Country:US
Mailing Address - Phone:240-432-1236
Mailing Address - Fax:
Practice Address - Street 1:7964 JASONS LANDING WAY
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2664
Practice Address - Country:US
Practice Address - Phone:240-432-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN188227163WW0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty