Healthcare Provider Details

I. General information

NPI: 1023345873
Provider Name (Legal Business Name): DEBORAH EKIGHALO OKONOFUA FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH EKIGHALO OKONOFUA FNP

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 BALTIMORE AVE STE 510
COLLEGE PARK MD
20740-3641
US

IV. Provider business mailing address

7100 BALTIMORE AVE STE 510
COLLEGE PARK MD
20740-3641
US

V. Phone/Fax

Practice location:
  • Phone: 240-467-5739
  • Fax: 240-467-5795
Mailing address:
  • Phone: 240-467-5739
  • Fax: 240-467-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003033
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: