Healthcare Provider Details

I. General information

NPI: 1437844826
Provider Name (Legal Business Name): GRACE ONYEKACHI EFEYINI AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE ONYEKACHI EFEYINI AGPCNP

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
ROSEDALE MD
21237-3901
US

IV. Provider business mailing address

PO BOX 43434
NOTTINGHAM MD
21236-0434
US

V. Phone/Fax

Practice location:
  • Phone: 410-812-2196
  • Fax:
Mailing address:
  • Phone: 443-777-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR217615
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: