Healthcare Provider Details

I. General information

NPI: 1972859619
Provider Name (Legal Business Name): MRS. PAULINE UZOAMAKA MUONEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9831 GREENBELT RD STE 102
LANHAM MD
20706-6211
US

IV. Provider business mailing address

9831 GREENBELT RD STE 102
LANHAM MD
20706-6211
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-4100
  • Fax: 301-552-1700
Mailing address:
  • Phone: 301-552-4100
  • Fax: 301-552-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR149303
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR149303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: