Healthcare Provider Details

I. General information

NPI: 1811724255
Provider Name (Legal Business Name): LOIS IMARIAGBE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N PHILADELPHIA BLVD
ABERDEEN MD
21001-2573
US

IV. Provider business mailing address

106 N PHILADELPHIA BLVD
ABERDEEN MD
21001-2573
US

V. Phone/Fax

Practice location:
  • Phone: 443-327-8373
  • Fax:
Mailing address:
  • Phone: 443-327-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN9524410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: