Healthcare Provider Details

I. General information

NPI: 1710849690
Provider Name (Legal Business Name): CHUKWUMA OKONKWO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 11/29/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MONTANA AVE NE APT 205
WASHINGTON DC
20018-3443
US

IV. Provider business mailing address

11405 COLTS NECK DR
UPPER MARLBORO MD
20772-2980
US

V. Phone/Fax

Practice location:
  • Phone: 202-705-9580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: