Healthcare Provider Details

I. General information

NPI: 1447670732
Provider Name (Legal Business Name): AKHERENWEI GWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 GREENWAY CENTER DR STE 700A
GREENBELT MD
20770-3523
US

IV. Provider business mailing address

310 PALADIUM CT UNIT 203
OWINGS MILLS MD
21117-1393
US

V. Phone/Fax

Practice location:
  • Phone: 301-982-3437
  • Fax:
Mailing address:
  • Phone: 617-461-3856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberNP15892
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 15892-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR167921
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR167921
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP15892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: