Provider Demographics
NPI:1134482615
Name:OTUYA, CHINYERE LOIS
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:LOIS
Last Name:OTUYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2375
Mailing Address - Country:US
Mailing Address - Phone:240-462-9940
Mailing Address - Fax:703-454-0722
Practice Address - Street 1:7600 GEORGIA AVE NW
Practice Address - Street 2:SUITE 323
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1616
Practice Address - Country:US
Practice Address - Phone:202-723-3060
Practice Address - Fax:202-723-3065
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1010504163WC0400X
MDR176612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management