Provider Demographics
NPI:1851910293
Name:OKOUGBO, JUSTINA CHRISTINA (MSN-FNP BC, RN-BC)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:CHRISTINA
Last Name:OKOUGBO
Suffix:
Gender:F
Credentials:MSN-FNP BC, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 MANDAN RD APT 302
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2852
Mailing Address - Country:US
Mailing Address - Phone:202-251-8334
Mailing Address - Fax:
Practice Address - Street 1:1242 12TH ST NE WASHINGTON D.C.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-269-6600
Practice Address - Fax:240-467-5795
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty