MEDICARE: NWANNEKA CHINONYELUM NDECHE CRNP-PMH

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R203560	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R203560	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R203560	OTHER	MD	CRNP-PMH

General Provider Information

NPI Number	:	1104414457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NWANNEKA CHINONYELUM NDECHE CRNP-PMH

Provider Business Mailing Address
First Line	:	1400 MERCANTILE LN STE 200
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5350
Country	:	US
Telephone Number	:	443-600-0776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MERCANTILE LN STE 200
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5350
Country	:	US
Telephone Number	:	443-600-0776
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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Directions to “ NWANNEKA CHINONYELUM NDECHE CRNP-PMH” Practice Location

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