MEDICARE: CHOSEN THERAPEUTIC SERVICES

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	363LP2300X	Primary Care Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1396468351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOSEN THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	9091 SNOWDEN PKWY #1188
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9091 SNOWDEN PKWY #1188
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-0000
Country	:	US
Telephone Number	:	443-819-0495
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MS. TYWANNA HAMILTON
Credential	:	NP
Telephone Number	:	443-819-0495

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	11/08/2022

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