Healthcare Provider Details

I. General information

NPI: 1225522618
Provider Name (Legal Business Name): ICARE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 108
LAUREL MD
20708-4233
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 108
LAUREL MD
20708-4233
US

V. Phone/Fax

Practice location:
  • Phone: 301-300-8624
  • Fax: 240-614-2750
Mailing address:
  • Phone: 301-300-8624
  • Fax: 240-614-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateMD

VIII. Authorized Official

Name: MS. EBERECHUKWU NWAOGU
Title or Position: MEDICAL DIRECTOR
Credential: FNP-BC
Phone: 301-300-8624