Provider Demographics
NPI:1285250191
Name:MICHAEL NWANDU DNP, PMHNP-BC, LLC
Entity type:Organization
Organization Name:MICHAEL NWANDU DNP, PMHNP-BC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR/DIR.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANDU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-900-7617
Mailing Address - Street 1:5702 COUNTRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1723
Mailing Address - Country:US
Mailing Address - Phone:410-900-7617
Mailing Address - Fax:
Practice Address - Street 1:5702 COUNTRY FARM ROAD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162
Practice Address - Country:US
Practice Address - Phone:443-501-2444
Practice Address - Fax:443-583-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health