Healthcare Provider Details

I. General information

NPI: 1487265864
Provider Name (Legal Business Name): ATOLA NNENNA IDIKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CRAIN HWY
WHITE PLAINS MD
20695-3045
US

IV. Provider business mailing address

1316 MINNESOTA WAY
UPPER MARLBORO MD
20774-6060
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-6700
  • Fax: 301-609-6741
Mailing address:
  • Phone: 202-702-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: