Provider Demographics
NPI:1073111209
Name:EHIEM, CHARITY IJEOMA (NP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:IJEOMA
Last Name:EHIEM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 GLYDON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5309
Mailing Address - Country:US
Mailing Address - Phone:240-350-8491
Mailing Address - Fax:
Practice Address - Street 1:6188 OXON HILL RD STE 601
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3152
Practice Address - Country:US
Practice Address - Phone:240-553-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty