Provider Demographics
NPI:1982364857
Name:ONUEKWUSI, KEVIN O SR (DNP)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:O
Last Name:ONUEKWUSI
Suffix:SR
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13206 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3603
Mailing Address - Country:US
Mailing Address - Phone:240-416-3684
Mailing Address - Fax:
Practice Address - Street 1:13206 4TH ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3603
Practice Address - Country:US
Practice Address - Phone:240-416-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153179363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty