Healthcare Provider Details

I. General information

NPI: 1376801118
Provider Name (Legal Business Name): MIRANDA BESSEM MBUTAMBE CRNP PMHNP DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE B201
CLINTON MD
20735-1605
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE B201
CLINTON MD
20735-1605
US

V. Phone/Fax

Practice location:
  • Phone: 301-289-7722
  • Fax: 301-441-2518
Mailing address:
  • Phone: 202-367-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR233930
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR233930
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1035293
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP1035293
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: