Healthcare Provider Details

I. General information

NPI: 1255722187
Provider Name (Legal Business Name): FLORENCE CHINWE UKENYE CRNP (NURSE PRACTITI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVENUE SUITE B205
CLINTON MD
20735
US

IV. Provider business mailing address

7700 OLD BRANCH AVENUE SUITE B205
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-4933
  • Fax:
Mailing address:
  • Phone: 301-877-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR162287
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: