Healthcare Provider Details

I. General information

NPI: 1376367813
Provider Name (Legal Business Name): ANGELINA ONYINYECHI EKWONYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LOBO CT
ABINGDON MD
21009-4302
US

IV. Provider business mailing address

1205 LOBO CT
ABINGDON MD
21009-4302
US

V. Phone/Fax

Practice location:
  • Phone: 443-318-2660
  • Fax: 443-318-2660
Mailing address:
  • Phone: 443-318-2660
  • Fax: 443-318-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR160746
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR160746
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: