Provider Demographics
NPI:1023585676
Name:ONYEIWU, IFEOMA C (NP-FAMILY)
Entity type:Individual
Prefix:MRS
First Name:IFEOMA
Middle Name:C
Last Name:ONYEIWU
Suffix:
Gender:F
Credentials:NP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 PATTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2990
Mailing Address - Country:US
Mailing Address - Phone:301-464-7601
Mailing Address - Fax:
Practice Address - Street 1:KRYSTAL MEDICAL ASSOCIATES, 12150 ANNAPOLIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENNDALE
Practice Address - State:MD
Practice Address - Zip Code:20769
Practice Address - Country:US
Practice Address - Phone:301-464-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR142679363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR142679OtherNP-FAMILY