Provider Demographics
NPI:1528547767
Name:IWEH, OBINNEAMAKA LESLEY (NP)
Entity Type:Individual
Prefix:MISS
First Name:OBINNEAMAKA
Middle Name:LESLEY
Last Name:IWEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6282 MCKAY CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2068
Mailing Address - Country:US
Mailing Address - Phone:410-491-3792
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 112
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1969
Practice Address - Country:US
Practice Address - Phone:410-514-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily