Healthcare Provider Details

I. General information

NPI: 1588837090
Provider Name (Legal Business Name): JOY CHIZOBAM AHANONU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W ROLLING CROSS RD STE 100
CATONSVILLE MD
21228-6280
US

IV. Provider business mailing address

4 W ROLLING XRDS STE 100
CATONSVILLE MD
21228-6277
US

V. Phone/Fax

Practice location:
  • Phone: 410-869-0100
  • Fax: 410-601-7317
Mailing address:
  • Phone: 410-869-0100
  • Fax: 410-601-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR159676
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: