MEDICARE: MRS. STELLA CHINONYEREM NNABUGWU

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	R196080	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R196080	MD

General Provider Information

NPI Number	:	1285236331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA CHINONYEREM NNABUGWU

Provider Business Mailing Address
First Line	:	2009 SAINT STEPHENS WOODS DR
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-2200
Country	:	US
Telephone Number	:	443-929-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 SAINT STEPHENS WOODS DR
Second Line	:
City	:	CROWNSVILLE
State	:	MD
Zip	:	21032-2200
Country	:	US
Telephone Number	:	443-929-9090
Fax Number	:

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

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	06/06/2024

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