Healthcare Provider Details

I. General information

NPI: 1508406653
Provider Name (Legal Business Name): PAMELA FRU TANGE ORIAIFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 205
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

PO BOX 44112
FORT WASHINGTON MD
20749-4112
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-4081
  • Fax: 240-632-0737
Mailing address:
  • Phone: 240-476-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1026242
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1026242
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR199916
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1026242
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR199916
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR199916
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: