Healthcare Provider Details

I. General information

NPI: 1164910675
Provider Name (Legal Business Name): IGBOANUZUO NDIDI ROSITA NJAKA AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-2601
US

IV. Provider business mailing address

14600 DERVISH CT
MITCHELLVILLE MD
20721-3092
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8577
  • Fax:
Mailing address:
  • Phone: 240-461-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR164318
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1019930
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP1019930
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR164318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: