Healthcare Provider Details

I. General information

NPI: 1770439044
Provider Name (Legal Business Name): CHIZOBA GLORY IBE CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W PATAPSCO AVE
BROOKLYN MD
21225-1604
US

IV. Provider business mailing address

6501 N CHARLES ST
TOWSON MD
21204-6819
US

V. Phone/Fax

Practice location:
  • Phone: 443-351-8926
  • Fax: 443-273-1186
Mailing address:
  • Phone: 410-938-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR259302
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: