Healthcare Provider Details

I. General information

NPI: 1124545587
Provider Name (Legal Business Name): LINDA BOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12504 KINGSVIEW ST
BOWIE MD
20721-2027
US

IV. Provider business mailing address

12504 KINGSVIEW ST
BOWIE MD
20721-2027
US

V. Phone/Fax

Practice location:
  • Phone: 443-648-1859
  • Fax:
Mailing address:
  • Phone: 443-648-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: