Healthcare Provider Details

I. General information

NPI: 1528564903
Provider Name (Legal Business Name): OGECHI O UKACHU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2601
US

IV. Provider business mailing address

14600 DERVISH CT
BOWIE MD
20721-3092
US

V. Phone/Fax

Practice location:
  • Phone: 202-730-0524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1028090
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1028090
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR200504
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: