Healthcare Provider Details

I. General information

NPI: 1588118095
Provider Name (Legal Business Name): NGOZI MARYANN OKUDOH DNP, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 215
WASHINGTON DC
20002-1849
US

IV. Provider business mailing address

11714 TUSCANY DR
LAUREL MD
20708-2841
US

V. Phone/Fax

Practice location:
  • Phone: 301-332-7222
  • Fax:
Mailing address:
  • Phone: 301-332-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1004337
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR160275
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR160275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: