Healthcare Provider Details

I. General information

NPI: 1154091767
Provider Name (Legal Business Name): UGONMA P NWOKORIE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 GOLF COURSE DR
BOWIE MD
20721-2326
US

IV. Provider business mailing address

1211 GOLF COURSE DR
BOWIE MD
20721-2326
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-8331
  • Fax:
Mailing address:
  • Phone: 301-728-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR184954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: