Provider Demographics
NPI:1770084998
Name:EMELOGU, VICTORIA NGOZI (CRNP-ADULT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NGOZI
Last Name:EMELOGU
Suffix:
Gender:F
Credentials:CRNP-ADULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2203
Mailing Address - Country:US
Mailing Address - Phone:443-851-9475
Mailing Address - Fax:
Practice Address - Street 1:3507 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:443-851-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148659363LP2300X
MDR148689363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care