Healthcare Provider Details

I. General information

NPI: 1083142442
Provider Name (Legal Business Name): PERPETUA ANTHONY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAYO RD, SUITE 201
EDGEWATER MD
21037-3808
US

IV. Provider business mailing address

11905 FROST DR
BOWIE MD
20720-4430
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-6800
  • Fax:
Mailing address:
  • Phone: 240-645-3674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157556
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR157556
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: