Provider Demographics
NPI:1457942575
Name:IHEDIOHANMA, BERNADINE
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:
Last Name:IHEDIOHANMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERNADINE
Other - Middle Name:
Other - Last Name:IHEDIOHANMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, NP-C, CRNP
Mailing Address - Street 1:9607 JUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9607 JUSTIN LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1801
Practice Address - Country:US
Practice Address - Phone:301-922-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily