| Vigor Integrative Wellness | |
|
1201 Seven Locks Rd Ste 360 Rockville MD 20854-6901 | |
| (301) 569-2502 | |
| Not Available |
| Full Name | Vigor Integrative Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 1201 Seven Locks Rd Ste 360, Rockville, Maryland |
| Authorized Official Name and Position | Kerniba Ghoneim (OWNER) |
| Authorized Official Contact | 3015692502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vigor Integrative Wellness 1201 Seven Locks Rd Ste 360 Rockville MD 20854-6901 | Vigor Integrative Wellness 1201 Seven Locks Rd Ste 360 Rockville MD 20854-6901 Ph: (301) 569-2502 |
| NPI Number | 1154036549 |
|---|---|
| Provider Enumeration Date | 01/19/2023 |
| Last Update Date | 02/14/2023 |
| Certification Date | 02/14/2023 |
| Medicare PECOS PAC ID | 6507238664 |
|---|---|
| Medicare Enrollment ID | O20230218000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154036549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Secondary |
| Provider Name | Kerniba Ghoneim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568036382 PECOS PAC ID: 0749679231 Enrollment ID: I20230218000314 |
| Provider Name | Miriam Chynwe Ezenwaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356061717 PECOS PAC ID: 7911366711 Enrollment ID: I20230711001686 |
| Provider Name | Anastasia Kotsakis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588227037 PECOS PAC ID: 8123569431 Enrollment ID: I20240926000050 |
| Provider Name | Josline Dibonge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598244196 PECOS PAC ID: 8527451236 Enrollment ID: I20241001004323 |
| Provider Name | Glynita Susann Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104157247 PECOS PAC ID: 2769914779 Enrollment ID: I20241016000029 |
| Provider Name | Somgolie Ozodigwe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487498754 PECOS PAC ID: 6608309646 Enrollment ID: I20241119004541 |
| Provider Name | Melissa Matthews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922769892 PECOS PAC ID: 5799179701 Enrollment ID: I20250123000518 |
| Provider Name | Foluke O Ajuwon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265987812 PECOS PAC ID: 0749782324 Enrollment ID: I20250904001652 |
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