Provider Demographics
NPI:1710600358
Name:KEVIN O ONUEKWUSI
Entity Type:Organization
Organization Name:KEVIN O ONUEKWUSI
Other - Org Name:OLIVE CLINIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUEKWUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, AGNP
Authorized Official - Phone:240-416-3684
Mailing Address - Street 1:3311 TOLEDO TER STE B204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-8149
Mailing Address - Country:US
Mailing Address - Phone:240-416-3684
Mailing Address - Fax:
Practice Address - Street 1:3311 TOLEDO TER STE B204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8149
Practice Address - Country:US
Practice Address - Phone:240-416-3684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty