Healthcare Provider Details

I. General information

NPI: 1174142624
Provider Name (Legal Business Name): NGOZI VIVIENNE OSUCHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-5506
US

IV. Provider business mailing address

9549 WESHURST LN
UPPER MARLBORO MD
20774-2434
US

V. Phone/Fax

Practice location:
  • Phone: 202-361-6817
  • Fax:
Mailing address:
  • Phone: 202-361-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1048284
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: