Healthcare Provider Details

I. General information

NPI: 1376406686
Provider Name (Legal Business Name): LILIAN CHINELO ACHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIAN CHINELO OBIDUM

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 EMMANUAL WAY
BOWIE MD
20716-1265
US

IV. Provider business mailing address

15400 EMMANUAL WAY
BOWIE MD
20716-1265
US

V. Phone/Fax

Practice location:
  • Phone: 240-917-8183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR231988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: