Healthcare Provider Details

I. General information

NPI: 1407092901
Provider Name (Legal Business Name): GINIKANWA NWANYIBUIFE UKPABI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

P O BOX 37215
BALTIMORE MD
21297-7215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2035
  • Fax: 202-476-2039
Mailing address:
  • Phone: 202-476-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN59279
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR117864
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: