Healthcare Provider Details

I. General information

NPI: 1871432286
Provider Name (Legal Business Name): TYRENE MAPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 201
WASHINGTON DC
20002-1849
US

IV. Provider business mailing address

2421 HARLEM AVE
BALTIMORE MD
21216-4837
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-5187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: