Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R219657 | MD |
NPI | 1023635877 |
---|---|
Provider Name | Emu Godspower Ohwobete |
First Address | Baltimore, MD 21237-4210 |
Second Address | Baltimore, MD 21237-4210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2020 |
Last Update Date | 08/09/2020 |