Provider Demographics
NPI:1205332814
Name:SMITH, NKIRU
Entity type:Individual
Prefix:
First Name:NKIRU
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NKIRU
Other - Middle Name:
Other - Last Name:NDUKWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 ANNAPOLIS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1334
Mailing Address - Country:US
Mailing Address - Phone:410-220-4449
Mailing Address - Fax:015-785-5551
Practice Address - Street 1:1215 ANNAPOLIS RD STE 101
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1334
Practice Address - Country:US
Practice Address - Phone:410-220-4449
Practice Address - Fax:301-576-5715
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154006363LP0808X, 163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily