Provider Demographics
NPI:1437798923
Name:IC HEALTH SERVICES INC
Entity type:Organization
Organization Name:IC HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:ONYEGWU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, PMHNP-BC
Authorized Official - Phone:301-793-0626
Mailing Address - Street 1:6720G RITCHIE HWY STE 417
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2319
Mailing Address - Country:US
Mailing Address - Phone:443-620-3616
Mailing Address - Fax:443-960-7963
Practice Address - Street 1:110 PAINTERS MILL RD STE 105
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5251
Practice Address - Country:US
Practice Address - Phone:443-620-3616
Practice Address - Fax:443-960-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty