Healthcare Provider Details

I. General information

NPI: 1750882841
Provider Name (Legal Business Name): IVONNE MBONE SONA NWADIKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 12/26/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 106
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

2357 TERRAPIN XING
JESSUP MD
20794-9830
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone: 240-423-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR212180
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1034535
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: