Healthcare Provider Details

I. General information

NPI: 1679991822
Provider Name (Legal Business Name): UCHENNA EKWONYE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: UCHENNA EKWONYE RN

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 OLD COURT RD STE 105
RANDALLSTOWN MD
21133-5281
US

IV. Provider business mailing address

5310 OLD COURT RD STE 105
RANDALLSTOWN MD
21133-5281
US

V. Phone/Fax

Practice location:
  • Phone: 443-687-2527
  • Fax:
Mailing address:
  • Phone: 443-687-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00127050
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR181213
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP44931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: