Healthcare Provider Details

I. General information

NPI: 1487589966
Provider Name (Legal Business Name): ADAEZE ONWUKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11204 LAKE VISTA LN
BOWIE MD
20721-2954
US

IV. Provider business mailing address

11204 LAKE VISTA LN
BOWIE MD
20721-2954
US

V. Phone/Fax

Practice location:
  • Phone: 240-556-8035
  • Fax:
Mailing address:
  • Phone: 240-556-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: