=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275107104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ALOYSIUS IKE AKPUAKA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2021
-----------------------------------------------------
Last Update Date | 05/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9470 ANNAPOLIS RD STE 115
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-3025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-708-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 PARKCREST CT
-----------------------------------------------------
City | UPPER MARLBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20774-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-706-4573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R142245
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------