Healthcare Provider Details

I. General information

NPI: 1699378281
Provider Name (Legal Business Name): ANGWI TAH EMILIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9733 COUNTRY MEADOWS LN APT 1A
LAUREL MD
20723-6306
US

IV. Provider business mailing address

9733 COUNTRY MEADOWS LN APT 1A
LAUREL MD
20723-6306
US

V. Phone/Fax

Practice location:
  • Phone: 443-985-4096
  • Fax:
Mailing address:
  • Phone: 443-985-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00187625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: