Healthcare Provider Details

I. General information

NPI: 1225454937
Provider Name (Legal Business Name): THERESA OGHOSOMHI OKEREKE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MAGOTHY BRIDGE RD. PASADENA, MD. 21122
BALTIMORE MD
21122
US

IV. Provider business mailing address

28 MAGOTHY BRIDGE RD. PASADENA, MD. 21122
BALTIMORE MD
21122
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-652-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR181818
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: