MEDICARE: GRACE OKHUEREIGBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	178662	MD

General Provider Information

NPI Number	:	1083169585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE OKHUEREIGBE

Provider Business Mailing Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	301-875-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 BALTIMORE AVE STE 510
Second Line	:
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-3641
Country	:	US
Telephone Number	:	301-875-5511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	01/09/2017

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Directions to “ GRACE OKHUEREIGBE ” Practice Location

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