Healthcare Provider Details

I. General information

NPI: 1083982607
Provider Name (Legal Business Name): PATRICIA UWAZURUONYE NJOKU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

3717B MCDONOGH RD
RANDALLSTOWN MD
21133-3802
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-1136
  • Fax: 410-502-1142
Mailing address:
  • Phone: 410-521-4856
  • Fax: 410-521-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR095655
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: