Healthcare Provider Details

I. General information

NPI: 1386013159
Provider Name (Legal Business Name): INNOCENT UWAKWE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 METZEROTT RD
COLLEGE PARK MD
20740-4425
US

IV. Provider business mailing address

3419 METZEROTT RD
COLLEGE PARK MD
20740-4425
US

V. Phone/Fax

Practice location:
  • Phone: 202-455-1747
  • Fax:
Mailing address:
  • Phone: 202-455-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1034716
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: