Healthcare Provider Details

I. General information

NPI: 1376802983
Provider Name (Legal Business Name): JOAN ESHO IRUAFEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD STE 402
LANHAM MD
20706-3059
US

IV. Provider business mailing address

5407 ANNETTE CT
UPPER MARLBORO MD
20772-2798
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-6319
  • Fax:
Mailing address:
  • Phone: 240-602-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR202589
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberR202589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: