Healthcare Provider Details

I. General information

NPI: 1275377442
Provider Name (Legal Business Name): JENNIFER MADUEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E ST SE
WASHINGTON DC
20003-2593
US

IV. Provider business mailing address

6101 STRAWBERRY GLENN CT
GLENN DALE MD
20769-9122
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9319
  • Fax:
Mailing address:
  • Phone: 240-726-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN500015165
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: