Healthcare Provider Details

I. General information

NPI: 1396501284
Provider Name (Legal Business Name): CHIOMA BEAUTY KWIZERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13110 LOCKWOODS PROGRESS DR
BOWIE MD
20720-6319
US

IV. Provider business mailing address

13 HICKORY HILL CT
SILVER SPRING MD
20906-5807
US

V. Phone/Fax

Practice location:
  • Phone: 720-989-9860
  • Fax:
Mailing address:
  • Phone: 720-989-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR242953
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR292453
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: