Provider Demographics
NPI:1831659002
Name:OKOROAFOR, NDUBUISI ISAAC (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NDUBUISI
Middle Name:ISAAC
Last Name:OKOROAFOR
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 EDDINGER RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-6329
Mailing Address - Country:US
Mailing Address - Phone:301-646-1481
Mailing Address - Fax:
Practice Address - Street 1:16410 EDDINGER RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-6329
Practice Address - Country:US
Practice Address - Phone:301-646-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194508363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health