Provider Demographics
NPI:1043682685
Name:IKOME, CHRISTIANA N (NP, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIANA
Middle Name:N
Last Name:IKOME
Suffix:
Gender:F
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10823 SHERWOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5826
Mailing Address - Country:US
Mailing Address - Phone:301-792-1433
Mailing Address - Fax:
Practice Address - Street 1:600 REISTERSTOWN RD STE 302
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5106
Practice Address - Country:US
Practice Address - Phone:301-792-1433
Practice Address - Fax:443-241-7250
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189380363L00000X, 363LF0000X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care