Healthcare Provider Details

I. General information

NPI: 1184488017
Provider Name (Legal Business Name): AMA BENTUMA ABBAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

8315 JENNEL CT
SEVERN MD
21144-2939
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3000
  • Fax:
Mailing address:
  • Phone: 301-437-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208451
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: