Healthcare Provider Details

I. General information

NPI: 1508162306
Provider Name (Legal Business Name): SHIRLEY FRIMPONG ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY COFFIE

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 CHAIRMANS CT STE 201A
FREDERICK MD
21703-2918
US

IV. Provider business mailing address

5205 CHAIRMANS CT STE 201A
FREDERICK MD
21703-2918
US

V. Phone/Fax

Practice location:
  • Phone: 240-629-3939
  • Fax: 240-629-3945
Mailing address:
  • Phone: 240-629-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024169024
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR174469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: