Healthcare Provider Details

I. General information

NPI: 1972092740
Provider Name (Legal Business Name): YVONNE NONYELUM OBIKE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 100
COLUMBIA MD
21045-3263
US

IV. Provider business mailing address

1300 MERCANTILE LN STE 200
LARGO MD
20774-5340
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 301-357-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR208795
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: