MEDICARE: KORLU WOLOBAH-KUYON

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	363LF0000X	Family Nurse Practitioner	R133750	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024178434	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R133750	MD

General Provider Information

NPI Number	:	1437522539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORLU WOLOBAH-KUYON

Provider Business Mailing Address
First Line	:	3739 CASTLE TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7836 OAKWOOD RD STE A
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4298
Country	:	US
Telephone Number	:	410-768-6011
Fax Number	:	410-929-8180

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

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	11/29/2020

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