Basic Information
| Provider Information | |||||||||
| NPI: | 1114510138 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OFFODILE | ||||||||
| FirstName: | IJEOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 SILVER SPRING AVE APT 429 | ||||||||
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| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209105094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305547919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 RESERVOIR RD NW | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200072113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024442000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2021 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RNA1056957 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.