Healthcare Provider Details

I. General information

NPI: 1063034213
Provider Name (Legal Business Name): ROSEMARY ONYEGBULA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 E CAPITOL ST NE
WASHINGTON DC
20003-1507
US

IV. Provider business mailing address

22 BLACKFOOT CT
MIDDLE RIVER MD
21220-3674
US

V. Phone/Fax

Practice location:
  • Phone: 202-371-9393
  • Fax:
Mailing address:
  • Phone: 443-630-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR176514
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: