Provider Demographics
NPI:1508141383
Name:AYICHI, OLUCHI JOSEPHINE
Entity Type:Individual
Prefix:
First Name:OLUCHI
Middle Name:JOSEPHINE
Last Name:AYICHI
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 1:6201 MARGLENN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2036
Mailing Address - Country:US
Mailing Address - Phone:410-350-6187
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:SUITE 110A
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:410-751-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily