Healthcare Provider Details

I. General information

NPI: 1386478782
Provider Name (Legal Business Name): ACCESS HEALTHCARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 NORTHVIEW DR STE 38
BOWIE MD
20716-2600
US

IV. Provider business mailing address

4305 NORTHVIEW DR STE 38
BOWIE MD
20716-2600
US

V. Phone/Fax

Practice location:
  • Phone: 301-235-9999
  • Fax: 301-235-9950
Mailing address:
  • Phone: 301-235-9999
  • Fax: 301-235-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IJEOMAH AHAGHOTU
Title or Position: OWNER
Credential:
Phone: 301-235-9999