Provider Demographics
NPI:1609405406
Name:NWOSU, BENJAMIN (NP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:NWOSU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 JORRICK CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7294
Mailing Address - Country:US
Mailing Address - Phone:240-565-3499
Mailing Address - Fax:
Practice Address - Street 1:15004 JORRICK CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7294
Practice Address - Country:US
Practice Address - Phone:240-565-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175013363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health