Healthcare Provider Details

I. General information

NPI: 1235504663
Provider Name (Legal Business Name): IKECHUKWU WILSON NWOSU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT RD FL 3
BRANDYWINE MD
20613-3035
US

IV. Provider business mailing address

7450 ALBERT RD FL 3
BRANDYWINE MD
20613-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax: 301-997-1489
Mailing address:
  • Phone: 301-888-2233
  • Fax: 301-997-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1023532
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR253041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: