Provider Demographics
NPI:1952099178
Name:OKPAH, ONYEANWUNA PATRICK
Entity type:Individual
Prefix:
First Name:ONYEANWUNA
Middle Name:PATRICK
Last Name:OKPAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7834 ROLLING VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3635
Mailing Address - Country:US
Mailing Address - Phone:443-600-3892
Mailing Address - Fax:
Practice Address - Street 1:7834 ROLLING VIEW AVE
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3635
Practice Address - Country:US
Practice Address - Phone:443-425-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212081363LP0808X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health