Healthcare Provider Details

I. General information

NPI: 1811317472
Provider Name (Legal Business Name): NKEM ZOS DR. DNP, CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANE SIA DR. DNP, CRNP-PMH

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13938 BALTIMORE AVE
LAUREL MD
20707-5000
US

IV. Provider business mailing address

13938 BALTIMORE AVE STE 3B
LAUREL MD
20707-5000
US

V. Phone/Fax

Practice location:
  • Phone: 301-769-6558
  • Fax:
Mailing address:
  • Phone: 301-769-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR170520
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: