Healthcare Provider Details

I. General information

NPI: 1467201632
Provider Name (Legal Business Name): ALIMATU MARIAMA KOROMA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DUTCHMANS LN
EASTON MD
21601-3342
US

IV. Provider business mailing address

8676 CAMAC ST
EASTON MD
21601-6205
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-8888
  • Fax:
Mailing address:
  • Phone: 410-725-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR175742
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: