Healthcare Provider Details

I. General information

NPI: 1316538705
Provider Name (Legal Business Name): HARRIET AGYEIWAA ASIEDU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KINDRED WAY SUITE 101
GLEN BURNIE MD
21061-5246
US

IV. Provider business mailing address

85 KINDRED WAY SUITE 101
GLEN BURNIE MD
21061-5246
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-6360
  • Fax: 410-553-6661
Mailing address:
  • Phone: 410-746-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR187082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: