MEDICARE: IFENYIWA HELEN OKONKWONWANIGWE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172V00000X	Community Health Worker
2	251S00000X	Community/Behavioral Health Agency
3	376K00000X	Nurse's Aide
4	374U00000X	Home Health Aide	DC

General Provider Information

NPI Number	:	1194655795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFENYIWA HELEN OKONKWONWANIGWE

Provider Business Mailing Address
First Line	:	11603 WYNNIFRED PL
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9481
Country	:	US
Telephone Number	:	240-521-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	11603 WYNNIFRED PL
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9481
Country	:	US
Telephone Number	:	240-521-8423
Fax Number	:

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

Provider Enumeration Date	:	05/23/2026
Last Update Date	:	05/23/2026

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