Healthcare Provider Details

I. General information

NPI: 1659985943
Provider Name (Legal Business Name): ROSEMOURINE CHINWENDU OBI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 218
WASHINGTON DC
20017-2106
US

IV. Provider business mailing address

1160 VARNUM STREET NE. SUITE #218, WASHINGTON, DISTRICT
WASHINGTON DC DC
20017-2324
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-6600
  • Fax:
Mailing address:
  • Phone: 202-269-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN1039612
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR235552
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN1039612
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1039612
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR235552
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: