Provider Demographics
NPI:1730639535
Name:OKUDO, CHINWE (CRNP DNP)
Entity Type:Individual
Prefix:DR
First Name:CHINWE
Middle Name:
Last Name:OKUDO
Suffix:
Gender:F
Credentials:CRNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9863 DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3776
Mailing Address - Country:US
Mailing Address - Phone:301-655-2927
Mailing Address - Fax:443-231-6380
Practice Address - Street 1:107 BEACON RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3504
Practice Address - Country:US
Practice Address - Phone:443-868-7405
Practice Address - Fax:443-231-7854
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198702363LF0000X
MDR193702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily