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General NPI Number Information
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NPI Number | 1215649686
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Entity Type | Individual
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Provider Name | NNEKA WOGU
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 12530 FAIRWOOD PKWY STE 102
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City | BOWIE
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State | MD
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Zip | 20720-6357
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Country | US
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Telephone | 301-900-5772
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Fax |
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Provider Business Mailing Address
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Address Line | 12331 QUILT PATCH LN
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City | BOWIE
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State | MD
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Zip | 20720-4358
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Country | US
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Telephone | 707-266-4997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R210021
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License Number State | MD
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