Healthcare Provider Details

I. General information

NPI: 1770848939
Provider Name (Legal Business Name): VICTORIA CHINAGOROM OKORIE-ANOCHIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 09/28/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HOWARD ST
ABERDEEN MD
21001-2445
US

IV. Provider business mailing address

31 HOWARD ST
ABERDEEN MD
21001-2445
US

V. Phone/Fax

Practice location:
  • Phone: 443-543-8432
  • Fax: 443-583-5902
Mailing address:
  • Phone: 443-543-8432
  • Fax: 443-583-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR173272
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR173272
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: