Provider Demographics
NPI:1801363593
Name:ONUEGBU, GRACE (CRNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ONUEGBU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7158
Mailing Address - Country:US
Mailing Address - Phone:443-635-4355
Mailing Address - Fax:
Practice Address - Street 1:8895 CENTRE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1966
Practice Address - Country:US
Practice Address - Phone:410-670-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201290363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health