Provider Demographics
NPI:1629491436
Name:ODIMEGWU, STELLA IFEYINWA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:IFEYINWA
Last Name:ODIMEGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELA
Other - Middle Name:IFEYINWA
Other - Last Name:ELUMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6856 EASTERN AVE NW
Mailing Address - Street 2:MAXIM HEALTHCARE SERVICES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2165
Mailing Address - Country:US
Mailing Address - Phone:240-667-1186
Mailing Address - Fax:240-667-1186
Practice Address - Street 1:6856 EASTERN AVE NW
Practice Address - Street 2:MAXIM HEALTHCARE SERVICES
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2165
Practice Address - Country:US
Practice Address - Phone:240-667-1186
Practice Address - Fax:240-667-1186
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1003997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse