Healthcare Provider Details

I. General information

NPI: 1578171393
Provider Name (Legal Business Name): ERINMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 EAGLES RIDGE CT
BROOKEVILLE MD
20833-1835
US

IV. Provider business mailing address

1812 EAGLES RIDGE CT
BROOKEVILLE MD
20833-1835
US

V. Phone/Fax

Practice location:
  • Phone: 301-640-6779
  • Fax:
Mailing address:
  • Phone: 301-640-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIET ERINMA MBONU
Title or Position: DIRECTOR
Credential: DNP, RN
Phone: 301-640-6779