=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831718030
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ONYINYECHI JENNIFER NWANAJUOBI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2020
-----------------------------------------------------
Last Update Date | 04/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12304 BALTIMORE AVE STE A
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-264-1692
-----------------------------------------------------
Fax | 240-264-1696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 N SUMMIT ST
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43604-1531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-427-1902
-----------------------------------------------------
Fax | 800-564-5952
-----------------------------------------------------
=====================================================
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 | RN176825
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------