Provider Demographics
NPI:1285236331
Name:NNABUGWU, STELLA CHINONYEREM
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:CHINONYEREM
Last Name:NNABUGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ONYEONORO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2009 SAINT STEPHENS WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2200
Mailing Address - Country:US
Mailing Address - Phone:443-929-9090
Mailing Address - Fax:
Practice Address - Street 1:2009 SAINT STEPHENS WOODS DR
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2200
Practice Address - Country:US
Practice Address - Phone:443-929-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196080163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health