Provider Demographics
NPI:1003450206
Name:EQUILLIBRIUM HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:EQUILLIBRIUM HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:ONYEGWU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C,PMHNP-BC
Authorized Official - Phone:301-793-0626
Mailing Address - Street 1:5364 TARKINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5407
Mailing Address - Country:US
Mailing Address - Phone:301-793-0626
Mailing Address - Fax:443-960-7963
Practice Address - Street 1:24 RIVER FRONT PL APT 206
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-7135
Practice Address - Country:US
Practice Address - Phone:301-793-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty