Healthcare Provider Details

I. General information

NPI: 1265131536
Provider Name (Legal Business Name): ISAAC OSEI OWUSU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 12/10/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 100
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

7859 TUCKAHOE CT
FULTON MD
20759-2599
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-7601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR215794
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: