Look up the most recent NPI and PECOS records

Atola Nnenna Idika

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9470 Annapolis Rd Ste 101, Lanham, MD 20706-4048

PECOS Enrollment

Based on the most recent information from CMS, provider Atola Nnenna Idika does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1487265864
Provider Type
Individual
Full Name
Idika, Atola Nnenna
Gender
Female

Sole Proprietor
Yes
Enumeration Date
8/11/2020
Last Updated
8/11/2020

Contact Information

Practice Location

9470 Annapolis Rd Ste 101, Lanham, MD 20706-4048

(301) 803-5833

Unlisted Fax

Mailing Location

1316 Minnesota Way, Upper Marlboro, MD 20774-6060

(202) 702-6789

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LP0808X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License R210401 Maryland

Provider Identifiers

ID	Description	Issuer
ID 05211985	Description Medicaid	Issuer Unlisted Maryland

Atola Nnenna Idika

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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