MEDICARE: AKUNNA CHISOM IKOCHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R204630	MD

General Provider Information

NPI Number	:	1124837810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKUNNA CHISOM IKOCHA

Provider Business Mailing Address
First Line	:	7375 EXECUTIVE PL STE 200
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6234
Country	:	US
Telephone Number	:	240-838-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 EXECUTIVE PL STE 200
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-6234
Country	:	US
Telephone Number	:	240-838-6354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	03/10/2026

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Directions to “ AKUNNA CHISOM IKOCHA ” Practice Location

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