Healthcare Provider Details

I. General information

NPI: 1740298579
Provider Name (Legal Business Name): IMMACULATA ULU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IMMACULATA UKOH NP

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ANNAPOLIS RD STE A8
LANHAM MD
20706-2060
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 240-582-7866
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR107244
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR107244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: