MEDICARE: MARIATU SULAIMAN GNP

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
1	363LG0600X	Gerontology Nurse Practitioner	R207471	MD

General Provider Information

NPI Number	:	1336919513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIATU SULAIMAN GNP

Provider Business Mailing Address
First Line	:	5504 GLEN AVE
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4718
Country	:	US
Telephone Number	:	240-604-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SETON DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3232
Country	:	US
Telephone Number	:	240-604-7064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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