Provider Demographics
NPI:1912603275
Name:EQUILIBRIUM HEALTH LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:ONYEGWU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,CRNP,FNP, PMHNP
Authorized Official - Phone:301-793-0626
Mailing Address - Street 1:5364 TARKINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5407
Mailing Address - Country:US
Mailing Address - Phone:301-793-0626
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST STE 200A
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5707
Practice Address - Country:US
Practice Address - Phone:619-936-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205271418OtherNPI