Healthcare Provider Details

I. General information

NPI: 1437824190
Provider Name (Legal Business Name): DAMATA PAYIDA-ANSAH DNP, CRNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/28/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E BELVEDERE AVE STE A
BALTIMORE MD
21212-3713
US

IV. Provider business mailing address

PO BOX 10744
SILVER SPRING MD
20914-0744
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-0018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR236001
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR236001
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: