Healthcare Provider Details

I. General information

NPI: 1740890862
Provider Name (Legal Business Name): GLORIA NWANKWO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 MEDICAL CENTER DR
ROCKVILLE MD
20850-6361
US

IV. Provider business mailing address

9861 DELLCASTLE RD
MONTGOMERY VILLAGE MD
20886-1324
US

V. Phone/Fax

Practice location:
  • Phone: 240-864-6007
  • Fax:
Mailing address:
  • Phone: 240-620-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10190086
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF10190086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: