Provider Demographics
NPI:1730989526
Name:BALENG OKUWOBI, JEANNE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BALENG OKUWOBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:BALENG OKUWOBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:2115 REGINA TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-8507
Mailing Address - Country:US
Mailing Address - Phone:301-339-4641
Mailing Address - Fax:301-339-4641
Practice Address - Street 1:2115 REGINA TER
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-8507
Practice Address - Country:US
Practice Address - Phone:301-339-4641
Practice Address - Fax:301-339-4641
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR237543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health