Provider Demographics
NPI:1154897973
Name:AISIDA, NNEKA (NP)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:
Last Name:AISIDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2198
Mailing Address - Country:US
Mailing Address - Phone:301-385-7676
Mailing Address - Fax:
Practice Address - Street 1:1371 HAWTHORN DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2198
Practice Address - Country:US
Practice Address - Phone:301-385-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR234948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF06180146OtherFNP LICENSE