Provider Demographics
NPI:1831522176
Name:NWAOGU, EBERECHUKWU (FNP-BC)
Entity type:Individual
Prefix:
First Name:EBERECHUKWU
Middle Name:
Last Name:NWAOGU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 CASTLE BLVD
Mailing Address - Street 2:APT 101
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4722
Mailing Address - Country:US
Mailing Address - Phone:301-802-5927
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR STE 300A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-4247
Practice Address - Country:US
Practice Address - Phone:301-300-8624
Practice Address - Fax:240-636-6899
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2012014104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily