Healthcare Provider Details

I. General information

NPI: 1003512781
Provider Name (Legal Business Name): MAUREEN A OHENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 GRAFTON CT
TRIANGLE VA
22172-1257
US

IV. Provider business mailing address

3813 GRAFTON CT
TRIANGLE VA
22172-1257
US

V. Phone/Fax

Practice location:
  • Phone: 757-254-9435
  • Fax:
Mailing address:
  • Phone: 757-254-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: