Provider Demographics
NPI:1780330472
Name:NANCY NYAKUNDI HENRIETTE KAREKEZI
Entity type:Organization
Organization Name:NANCY NYAKUNDI HENRIETTE KAREKEZI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-484-6817
Mailing Address - Street 1:525 EASTERN AVE # B1
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1677
Mailing Address - Country:US
Mailing Address - Phone:301-580-4776
Mailing Address - Fax:
Practice Address - Street 1:525 EASTERN AVE # B1
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1677
Practice Address - Country:US
Practice Address - Phone:301-580-4776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty