Provider Demographics
NPI:1821519554
Name:IHENACHOR, REGINA OKWUAKU
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:OKWUAKU
Last Name:IHENACHOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 LANDOVER RD APT 101
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1409
Mailing Address - Country:US
Mailing Address - Phone:240-616-8573
Mailing Address - Fax:
Practice Address - Street 1:9500 ARENA DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-3701
Practice Address - Country:US
Practice Address - Phone:301-655-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
DCHHA200003365374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI-526-734-659-686OtherDRIVING LICENSE
MDLIN1790068616OtherWORK AUTHORIZATION