Healthcare Provider Details

I. General information

NPI: 1811777196
Provider Name (Legal Business Name): IFEANYI OGBECHIE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

10121 ELLARD DR
LANHAM MD
20706-2082
US

V. Phone/Fax

Practice location:
  • Phone: 202-285-3772
  • Fax:
Mailing address:
  • Phone: 301-237-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR102798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: