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General NPI Number Information
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NPI Number | 1497385538
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Entity Type | Individual
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Provider Name | IFEYINWA MADUKA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 12304 BALTIMORE AVE STE A
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City | BELTSVILLE
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State | MD
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Zip | 20705-1314
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Country | US
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Telephone | 301-383-0142
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Fax |
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Provider Business Mailing Address
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Address Line | 12100 ANNAPOLIS RD UNIT 2
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City | GLENN DALE
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State | MD
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Zip | 20769-9179
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Country | US
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Telephone |
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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 | R178338
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License Number State | MD
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