MEDICARE: LINDA UKEJE CRNP

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	363LG0600X	Gerontology Nurse Practitioner	R196004	MD

General Provider Information

NPI Number	:	1649795857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA UKEJE CRNP

Provider Business Mailing Address
First Line	:	1502 SILVERADO CT
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-3149
Country	:	US
Telephone Number	:	301-792-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 MERCANTILE LN STE 200
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-5340
Country	:	US
Telephone Number	:	301-792-7373
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	08/08/2017

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