Healthcare Provider Details

I. General information

NPI: 1346752433
Provider Name (Legal Business Name): AGATHA N UKAEGBU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2017
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 MAYFLOWER RD
ROSEDALE MD
21237-4371
US

IV. Provider business mailing address

8915 MAYFLOWER RD
ROSEDALE MD
21237-4371
US

V. Phone/Fax

Practice location:
  • Phone: 443-857-4507
  • Fax:
Mailing address:
  • Phone: 443-857-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR143807
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2017019195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: