Healthcare Provider Details

I. General information

NPI: 1467149625
Provider Name (Legal Business Name): UGOCHINYERE RAVEN OKECHUKU-WACHUKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

IV. Provider business mailing address

220 CAMPUS WAY N
NORTH LITTLE ROCK AR
72113
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 210-485-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE-19745
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: