Healthcare Provider Details

I. General information

NPI: 1356030050
Provider Name (Legal Business Name): CHIFUMNANYA ANTHONIA OBIMAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 FORBES BLVD STE A
LANHAM MD
20706-4853
US

IV. Provider business mailing address

4325 FORBES BLVD STE A
LANHAM MD
20706-4853
US

V. Phone/Fax

Practice location:
  • Phone: 240-713-0041
  • Fax:
Mailing address:
  • Phone: 240-713-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR230446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: