Provider Demographics
NPI:1033085709
Name:IFEAMAZI, NNENNA GENEVIEVE
Entity type:Individual
Prefix:
First Name:NNENNA
Middle Name:GENEVIEVE
Last Name:IFEAMAZI
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 1:2589 AMBLING CIR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2712
Mailing Address - Country:US
Mailing Address - Phone:301-335-4264
Mailing Address - Fax:
Practice Address - Street 1:2589 AMBLING CIR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2712
Practice Address - Country:US
Practice Address - Phone:301-335-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1052877171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator