Healthcare Provider Details

I. General information

NPI: 1831688985
Provider Name (Legal Business Name): JOSEPHINE NKECHINYERE EZEMOBI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 PENNSYLVANIA AVE NW
WASHINGTON DC
20004-2404
US

IV. Provider business mailing address

811 FESTIVAL CT
BOWIE MD
20721-3170
US

V. Phone/Fax

Practice location:
  • Phone: 202-638-4583
  • Fax:
Mailing address:
  • Phone: 301-503-4124
  • Fax: 301-503-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1023962
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: