Provider Demographics
NPI:1598418956
Name:OBIORA, IKECHUKWU (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:
Last Name:OBIORA
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST STE 804
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5987
Mailing Address - Country:US
Mailing Address - Phone:240-898-1810
Mailing Address - Fax:240-493-8657
Practice Address - Street 1:1800 N CHARLES ST STE 804
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5987
Practice Address - Country:US
Practice Address - Phone:240-898-1810
Practice Address - Fax:240-493-8657
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR243288363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health