Healthcare Provider Details

I. General information

NPI: 1568081016
Provider Name (Legal Business Name): NOEL UCHE OSUCHUKWU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NOEL U OSUCHUKWU RN

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

901 1ST ST NW
WASHINGTON DC
20001-1403
US

IV. Provider business mailing address

9549 WESHURST LN
UPPER MARLBORO MD
20774-2434
US

V. Phone/Fax

Practice location:
  • Phone: 202-669-5750
  • Fax:
Mailing address:
  • Phone: 202-669-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1031903
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: