Healthcare Provider Details

I. General information

NPI: 1922884949
Provider Name (Legal Business Name): MURREN ISIOMA OKOCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MURREN ISIOMA OKOH

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

3441 HENRY HARFORD DRIVE
ABINGDON MD
21009
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone: 443-469-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR28226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: