Healthcare Provider Details

I. General information

NPI: 1275894503
Provider Name (Legal Business Name): MABI T NTUMAZAH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CRAIN HWY S STE 3
GLEN BURNIE MD
21061-3657
US

IV. Provider business mailing address

420 CRAIN HWY S STE 3
GLEN BURNIE MD
21061-3657
US

V. Phone/Fax

Practice location:
  • Phone: 410-595-6199
  • Fax: 410-684-5334
Mailing address:
  • Phone: 410-595-6199
  • Fax: 410-684-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR205083
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: