Healthcare Provider Details

I. General information

NPI: 1457942575
Provider Name (Legal Business Name): BERNADINE IHEDIOHANMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNADINE IHEDIOHANMA DNP, NP-C, CRNP

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 V ST NE
WASHINGTON DC
20002-1329
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

V. Phone/Fax

Practice location:
  • Phone: 551-295-8223
  • Fax:
Mailing address:
  • Phone: 551-295-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR172509
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: