Healthcare Provider Details

I. General information

NPI: 1770961708
Provider Name (Legal Business Name): NKECHI EGBOGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 FISHERMENS CT
CLINTON MD
20735-1572
US

IV. Provider business mailing address

721 48TH ST NE # EAST
WASHINGTON DC
20019-3607
US

V. Phone/Fax

Practice location:
  • Phone: 443-707-9611
  • Fax:
Mailing address:
  • Phone: 202-541-9844
  • Fax: 202-541-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11198
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500007851
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: