Healthcare Provider Details

I. General information

NPI: 1194068866
Provider Name (Legal Business Name): OGOCHUKWU ENYI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8506 SNOWDEN LOOP
LAUREL MD
20708-2360
US

IV. Provider business mailing address

8506 SNOWDEN LOOP
LAUREL MD
20708
US

V. Phone/Fax

Practice location:
  • Phone: 240-501-0232
  • Fax:
Mailing address:
  • Phone: 240-501-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1028341
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR203505
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR1028341
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: