Healthcare Provider Details

I. General information

NPI: 1023940251
Provider Name (Legal Business Name): OGECHI JOY EKWUNAZU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 HARFORD RD
BALTIMORE MD
21214-2233
US

IV. Provider business mailing address

7714 JENELLES LN
NOTTINGHAM MD
21236-3727
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-4886
  • Fax:
Mailing address:
  • Phone: 443-801-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR22411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: