Healthcare Provider Details

I. General information

NPI: 1457086522
Provider Name (Legal Business Name): NEW ERA PROFESSIONAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 CROSSETT RD
BALTIMORE MD
21237-1462
US

IV. Provider business mailing address

2312 CROSSETT RD
BALTIMORE MD
21237-1462
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-3559
  • Fax: 410-866-6476
Mailing address:
  • Phone: 443-983-3559
  • Fax: 410-866-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCA ONYEDUM
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 443-983-3559