Healthcare Provider Details

I. General information

NPI: 1528531498
Provider Name (Legal Business Name): JOY OKWUCHI UWANDU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PHILADELPHIA BLVD STE A
ABERDEEN MD
21001-2568
US

IV. Provider business mailing address

7202 HANOVER PKWY STE A
GREENBELT MD
20770-2004
US

V. Phone/Fax

Practice location:
  • Phone: 443-530-3182
  • Fax: 443-399-8223
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR157374
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR157374
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: