Healthcare Provider Details

I. General information

NPI: 1487488490
Provider Name (Legal Business Name): GETNET TIKU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 ARCHER ST
BALTIMORE MD
21230-2516
US

IV. Provider business mailing address

624 ARCHER ST
BALTIMORE MD
21230-2516
US

V. Phone/Fax

Practice location:
  • Phone: 443-803-2460
  • Fax:
Mailing address:
  • Phone: 443-803-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number80884
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: