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NPI Code Detail

MEDICARE: EVELYN OMOREGBEE

MEDICARE: EVELYN OMOREGBEE
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
1363LF0000XFamily Nurse PractitionerR178660MD
2363LF0000XFamily Nurse PractitionerRN1022101DC

General Provider Information

NPI Number : 1659701522
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN OMOREGBEE
Provider Business Mailing Address
First Line : 14903 DENNINGTON DR
Second Line :
City : BOWIE
State : MD
Zip : 20721-3277
Country : US
Telephone Number : 301-335-3941
Fax Number :
Provider Business Practice Location Address
First Line : 2003 DAVIDSONVILLE RD
Second Line :
City : CROFTON
State : MD
Zip : 21114-1317
Country : US
Telephone Number : 301-335-3941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2013
Last Update Date : 01/15/2018

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