Healthcare Provider Details

I. General information

NPI: 1104734300
Provider Name (Legal Business Name): NKEIRUKA CHINWENDU UNAEGBU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 ETON DR
UPPER MARLBORO MD
20772-6800
US

IV. Provider business mailing address

3511 ETON DR
UPPER MARLBORO MD
20772-6800
US

V. Phone/Fax

Practice location:
  • Phone: 240-481-6049
  • Fax:
Mailing address:
  • Phone: 240-481-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR204574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: