Healthcare Provider Details

I. General information

NPI: 1578425484
Provider Name (Legal Business Name): OLUCHI VICTORY UKAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST # 4332
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

306 W REDWOOD ST # 4332
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 240-822-9130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR254703
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: