Healthcare Provider Details

I. General information

NPI: 1255729463
Provider Name (Legal Business Name): CHIMDINMA DEBORAH OJINI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVE STE 100
TAKOMA PARK MD
20912
US

IV. Provider business mailing address

7610 CARROLL AVE STE 100
TAKOMA PARK MD
20912-6311
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-2500
  • Fax: 301-448-1679
Mailing address:
  • Phone: 301-891-2500
  • Fax: 301-448-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1013389
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1013389
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: