Provider Demographics
NPI:1336638089
Name:MBAKPUO, NDIDIAMAKA EZINNE (FNP)
Entity Type:Individual
Prefix:
First Name:NDIDIAMAKA
Middle Name:EZINNE
Last Name:MBAKPUO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:DR
Other - First Name:NDIDIAMAKA
Other - Middle Name:EZINNE
Other - Last Name:MBAKPUO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:13101 JORDANS ENDEAVOR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3392
Mailing Address - Country:US
Mailing Address - Phone:202-735-1010
Mailing Address - Fax:
Practice Address - Street 1:9470 ANNAPOLIS RD STE 416
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3000
Practice Address - Country:US
Practice Address - Phone:202-735-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1015877363LF0000X
MDR184944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily