Healthcare Provider Details

I. General information

NPI: 1508416777
Provider Name (Legal Business Name): MAUREEN N. OSEGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 KINGSVIEW ST
BOWIE MD
20721-2028
US

IV. Provider business mailing address

12505 KINGSVIEW ST
BOWIE MD
20721-2028
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-8205
  • Fax:
Mailing address:
  • Phone: 240-565-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204393
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1031508
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03240094
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: