Healthcare Provider Details

I. General information

NPI: 1770084998
Provider Name (Legal Business Name): VICTORIA NGOZI EMELOGU CRNP-ADULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 N ROLLING RD
WINDSOR MILL MD
21244
US

IV. Provider business mailing address

3507 N ROLLING RD
WINDSOR MILL MD
21244-2203
US

V. Phone/Fax

Practice location:
  • Phone: 443-851-9475
  • Fax:
Mailing address:
  • Phone: 443-851-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR148689
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR148659
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: