Healthcare Provider Details

I. General information

NPI: 1992651665
Provider Name (Legal Business Name): ANGELA CHIZOBA IHEANACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7629 CEDAR POND LN
BALTIMORE MD
21237-3742
US

IV. Provider business mailing address

7629 CEDAR POND LN
BALTIMORE MD
21237-3742
US

V. Phone/Fax

Practice location:
  • Phone: 512-669-3240
  • Fax: 410-870-1779
Mailing address:
  • Phone: 512-669-3240
  • Fax: 410-870-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR184065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: