Healthcare Provider Details

I. General information

NPI: 1124837810
Provider Name (Legal Business Name): AKUNNA CHISOM IKOCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 200
LANHAM MD
20706-6234
US

IV. Provider business mailing address

7375 EXECUTIVE PL STE 200
LANHAM MD
20706-6234
US

V. Phone/Fax

Practice location:
  • Phone: 240-838-6354
  • Fax: 919-694-0925
Mailing address:
  • Phone: 240-838-6354
  • Fax: 919-694-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR204630
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: