Healthcare Provider Details

I. General information

NPI: 1427893106
Provider Name (Legal Business Name): CHIKA GERTRUDE OKOROAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

16410 EDDINGER RD
BOWIE MD
20716-6329
US

V. Phone/Fax

Practice location:
  • Phone: 240-360-0209
  • Fax:
Mailing address:
  • Phone: 301-646-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06240006
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: