Individual provider Active NPI

Grace Udo

  • Licensed Practical Nurse
  • Bowie, MD
National Provider Identifier
1588931653
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
LPN961787 Issued in DC
Practice address
13927 Westview Forest Dr
Bowie, MD 20720-4866
Phone
(301) 789-1006
NPI assigned
Nov 17, 2011
Last updated
Nov 17, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LPN961787 DC Primary

Addresses

Primary practice location

13927 Westview Forest Dr
Bowie, MD 20720-4866

Mailing address

13927 Westview Forest Dr
Bowie, MD 20720-4866
Phone (301) 789-1006

Other identifiers 1

IdentifierTypeStateIssuer
27-3767580OtherTAX ID#27-3767580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPN961787DCMDLicensed Practical Nurse

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1588931653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13927 WESTVIEW FOREST DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204866",
            "telephone_number": "301-789-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13927 WESTVIEW FOREST DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204866",
            "telephone_number": "301-789-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDO",
        "first_name": "GRACE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "DC",
            "license": "LPN961787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#27-3767580",
            "identifier": "27-3767580",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.