Healthcare Provider Details

I. General information

NPI: 1164341871
Provider Name (Legal Business Name): HERMELLA YILMA AGACNP-BC, MSMHA, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

45 RIDGE RD
GREENBELT MD
20770-7724
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8667
  • Fax:
Mailing address:
  • Phone: 410-328-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR279317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: