Healthcare Provider Details

I. General information

NPI: 1235893363
Provider Name (Legal Business Name): OBINNA CHUKWUEBUKA OKONKWO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 400E46
LANHAM MD
20706-2278
US

IV. Provider business mailing address

1450 MERCANTILE LN STE 243
UPPER MARLBORO MD
20774-5464
US

V. Phone/Fax

Practice location:
  • Phone: 240-761-3886
  • Fax: 301-686-3268
Mailing address:
  • Phone: 240-761-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR223763
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR223763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: