Healthcare Provider Details

I. General information

NPI: 1699162016
Provider Name (Legal Business Name): NKECHI OKWARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 ANNAPOLIS RD STE 316
GLENN DALE MD
20769-9182
US

IV. Provider business mailing address

12200 ANNAPOLIS RD STE 316
GLENN DALE MD
20769-9182
US

V. Phone/Fax

Practice location:
  • Phone: 301-313-0600
  • Fax: 301-383-0478
Mailing address:
  • Phone: 301-313-0600
  • Fax: 301-383-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR113209
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: