Provider Demographics
NPI:1750920179
Name:OGBENNAH, JECINTA CHINYERE (CRNP)
Entity type:Individual
Prefix:
First Name:JECINTA
Middle Name:CHINYERE
Last Name:OGBENNAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 AARON MEE WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4337
Mailing Address - Country:US
Mailing Address - Phone:443-474-6439
Mailing Address - Fax:
Practice Address - Street 1:6629 AARON MEE WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4337
Practice Address - Country:US
Practice Address - Phone:443-474-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170322363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology