Healthcare Provider Details

I. General information

NPI: 1881523728
Provider Name (Legal Business Name): HANNAH MAIYE BAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 RIVULET LN
LAUREL MD
20724-1340
US

IV. Provider business mailing address

3405 RIVULET LN
LAUREL MD
20724-1340
US

V. Phone/Fax

Practice location:
  • Phone: 240-515-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025094767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: