=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205577129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUER HAPPY SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 02/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15802 PACIFIC CT
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716-1632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-602-7044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15802 PACIFIC CT
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716-1632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-377-9313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CRNP-PMH
-----------------------------------------------------
Name | MS. EZINWANNE JUDITH IROBEREACHI
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 301-377-9313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------