Healthcare Provider Details

I. General information

NPI: 1427813997
Provider Name (Legal Business Name): AMINA COLE-KANGBAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMINATA SANKOH

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
BALTIMORE MD
21207-6665
US

IV. Provider business mailing address

8316 RIVER PARK RD
BOWIE MD
20715-3378
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone: 240-280-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR225602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: