Provider Demographics
NPI:1245719202
Name:ONWUEGBULE, PHILOMENA (CRNP FAMILY)
Entity type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:ONWUEGBULE
Suffix:
Gender:F
Credentials:CRNP FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7947 MONROVIA DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1098
Mailing Address - Country:US
Mailing Address - Phone:410-903-9948
Mailing Address - Fax:
Practice Address - Street 1:13992 BALTIMORE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5010
Practice Address - Country:US
Practice Address - Phone:240-264-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR129518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR129518Medicaid