Healthcare Provider Details

I. General information

NPI: 1104819267
Provider Name (Legal Business Name): DIONNE MEBANE-ASHTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LIBERTY HEIGHTS AVE
BALTIMORE MD
21215-8019
US

IV. Provider business mailing address

2614 RAINY SPRING CT
ODENTON MD
21113-3304
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax: 410-383-3160
Mailing address:
  • Phone: 410-305-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR139607
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: