Provider Demographics
NPI:1235893363
Name:OKONKWO, OBINNA CHUKWUEBUKA (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:OBINNA
Middle Name:CHUKWUEBUKA
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MERCANTILE LN
Mailing Address - Street 2:STE 243
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5464
Mailing Address - Country:US
Mailing Address - Phone:240-761-3886
Mailing Address - Fax:
Practice Address - Street 1:1450 MERCANTILE LN STE 243
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5464
Practice Address - Country:US
Practice Address - Phone:240-761-3886
Practice Address - Fax:301-686-3268
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223763163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty