Healthcare Provider Details

I. General information

NPI: 1659968642
Provider Name (Legal Business Name): LAURETTE ETAKA ABUNAW PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3296
US

IV. Provider business mailing address

5457 TWIN KNOLLS RD STE 300N17
COLUMBIA MD
21045-3259
US

V. Phone/Fax

Practice location:
  • Phone: 443-991-0090
  • Fax: 443-545-7795
Mailing address:
  • Phone: 443-991-0090
  • Fax: 443-545-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR221410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: