Healthcare Provider Details

I. General information

NPI: 1730441239
Provider Name (Legal Business Name): EUNICE ENEANYA UDIANI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 WHISTLING DUCK DR
UPPER MARLBORO MD
20774-7103
US

IV. Provider business mailing address

1504 WHISTLING DUCK DR
UPPER MARLBORO MD
20774-7103
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-7436
  • Fax:
Mailing address:
  • Phone: 301-523-7436
  • Fax: 240-838-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR223961
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR223961
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: