Provider Demographics
NPI:1811582802
Name:JOACHIM OKONKWO, NONYELUM EMILIA
Entity type:Individual
Prefix:
First Name:NONYELUM
Middle Name:EMILIA
Last Name:JOACHIM OKONKWO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 ANNAPOLIS RD APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3104
Mailing Address - Country:US
Mailing Address - Phone:312-824-5720
Mailing Address - Fax:
Practice Address - Street 1:8619 ANNAPOLIS RD APT 2
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3104
Practice Address - Country:US
Practice Address - Phone:312-824-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCNA20202602Medicaid