Healthcare Provider Details

I. General information

NPI: 1851910293
Provider Name (Legal Business Name): JUSTINA CHRISTINA OKOUGBO MSN-FNP BC, RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 12TH ST NE WASHINGTON D.C.
WASHINGTON DC
20018
US

IV. Provider business mailing address

8003 MANDAN RD APT 302
GREENBELT MD
20770-2852
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-6600
  • Fax: 240-467-5795
Mailing address:
  • Phone: 202-251-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208765
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: