Healthcare Provider Details

I. General information

NPI: 1992668420
Provider Name (Legal Business Name): MRS. JESSICA UKANDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20410 OBSERVATION DR STE 100
GERMANTOWN MD
20876-6419
US

IV. Provider business mailing address

20410 OBSERVATION DR STE 100
GERMANTOWN MD
20876-6419
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-0277
  • Fax: 301-330-9108
Mailing address:
  • Phone: 301-762-0277
  • Fax: 301-330-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR239978
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: