Provider Demographics
NPI:1104414457
Name:NDECHE, NWANNEKA CHINONYELUM (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:NWANNEKA
Middle Name:CHINONYELUM
Last Name:NDECHE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5350
Mailing Address - Country:US
Mailing Address - Phone:443-600-0776
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 200
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5350
Practice Address - Country:US
Practice Address - Phone:443-600-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203560163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR203560OtherCRNP-PMH