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NPI Code Detail

MEDICARE: HENRIETTA SAGOE PMHNP-BC

MEDICARE: HENRIETTA SAGOE PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerR182948MD

General Provider Information

NPI Number : 1003533415
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRIETTA SAGOE PMHNP-BC
Provider Business Mailing Address
First Line : 13017 WISTERIA DR STE 114
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-2621
Country : US
Telephone Number : 301-812-4540
Fax Number : 301-238-7850
Provider Business Practice Location Address
First Line : 12800 MIDDLEBROOK RD STE 400
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-5282
Country : US
Telephone Number : 301-515-2901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2022
Last Update Date : 11/21/2023

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Directions to “ HENRIETTA SAGOE PMHNP-BC” Practice Location

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