Healthcare Provider Details

I. General information

NPI: 1407629116
Provider Name (Legal Business Name): CHIDERA HEALTH AND MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14258 OXFORD DR
LAUREL MD
20707-5854
US

IV. Provider business mailing address

14258 OXFORD DR
LAUREL MD
20707-5854
US

V. Phone/Fax

Practice location:
  • Phone: 240-978-7515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CLEMENTINA NWANDU
Title or Position: CEO
Credential: CRNP
Phone: 240-978-7515