Healthcare Provider Details

I. General information

NPI: 1194655795
Provider Name (Legal Business Name): IFENYIWA HELEN OKONKWONWANIGWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 WYNNIFRED PL
GLENN DALE MD
20769-9481
US

IV. Provider business mailing address

11603 WYNNIFRED PL
GLENN DALE MD
20769-9481
US

V. Phone/Fax

Practice location:
  • Phone: 240-521-8423
  • Fax:
Mailing address:
  • Phone: 240-521-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: