Provider Demographics
NPI:1922599356
Name:OWUNWANNE, PATIENCE
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:OWUNWANNE
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 1:5104 CHESHIRE LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4165
Mailing Address - Country:US
Mailing Address - Phone:240-603-0984
Mailing Address - Fax:
Practice Address - Street 1:4719 HAMPDEN LN STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3079
Practice Address - Country:US
Practice Address - Phone:301-656-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered