Organization
ICON MEDICINE
Active
Other names
INNOVATIVE CARE OPTIONS NETWORK
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY NYAKANGO ONSERIO DNP,APRN,FNP,CRNP (CLINICAL DIRECTOR)
(240) 966-4266
Entity
Organization
Contact information
Practice address
7411 RIGGS RD STE 300B, HYATTSVILLE, MD 20783-4246
(240) 966-4266
(301) 235-1771
Mailing address
10770 COLUMBIA PIKE STE 300-1021, SILVER SPRING, MD 20901-4402
(240) 966-4266
(301) 235-1771
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024189089
APRN LICENSE
VA
01
—
APRN11022989
APRN LICENSE
FL
01
—
O-526793646572
DRIVERS LICENSE
MD
01
—
R189170
CRNP LICENSE
MD
Enumeration date
01/24/2023
Last updated
02/24/2025
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