Healthcare Provider Details

I. General information

NPI: 1134914567
Provider Name (Legal Business Name): TANIA GERTRUDE NIAMKEY CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 MARYLAND AVE
BALTIMORE MD
21218-4518
US

IV. Provider business mailing address

2641 MARYLAND AVE
BALTIMORE MD
21218-4518
US

V. Phone/Fax

Practice location:
  • Phone: 240-355-1475
  • Fax:
Mailing address:
  • Phone: 240-355-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210475
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR210475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: