Healthcare Provider Details

I. General information

NPI: 1760375422
Provider Name (Legal Business Name): ROSALIE IYELIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALIE IYELIE

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 THOMAS JOHNSON DR STE 109
FREDERICK MD
21702-4425
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-1000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500340189
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC008668
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberRN61349738
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN61349738
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: