Healthcare Provider Details

I. General information

NPI: 1578307690
Provider Name (Legal Business Name): GERALDINE NWIWU-ENYINNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 BALTIMORE ANNAPOLIS BLVD
GLEN BURNIE MD
21061-1431
US

IV. Provider business mailing address

8120 MOUNTAIN VIEW CIR
PASADENA MD
21122-7700
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1057745
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR242960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: