Healthcare Provider Details

I. General information

NPI: 1477049617
Provider Name (Legal Business Name): ONAEDO ACHEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 ALABAMA AVE SE
WASHINGTON DC
20032
US

IV. Provider business mailing address

350 N CLARK ST FL 6
CHICAGO IL
60654-4712
US

V. Phone/Fax

Practice location:
  • Phone: 312-274-4524
  • Fax:
Mailing address:
  • Phone: 312-274-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001906
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2023028005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: