Healthcare Provider Details

I. General information

NPI: 1013313550
Provider Name (Legal Business Name): CHIDIMMA UCHE NWABUEZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SWEET CHERRY CT
SEVERN MD
21144-2670
US

IV. Provider business mailing address

1407 SWEET CHERRY CT
SEVERN MD
21144-2670
US

V. Phone/Fax

Practice location:
  • Phone: 240-467-7450
  • Fax:
Mailing address:
  • Phone: 240-467-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR221488
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: