Provider Demographics
NPI:1417455932
Name:NNEBEDUM, RUPHINA OGECHI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RUPHINA
Middle Name:OGECHI
Last Name:NNEBEDUM
Suffix:
Gender:F
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 1:10706 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6019
Mailing Address - Country:US
Mailing Address - Phone:240-374-2906
Mailing Address - Fax:
Practice Address - Street 1:10903 INDIAN HEAD HWY STE 504
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4012
Practice Address - Country:US
Practice Address - Phone:240-493-4704
Practice Address - Fax:301-753-7003
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1027656163WH0200X
MDR202505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health