Healthcare Provider Details

I. General information

NPI: 1841090958
Provider Name (Legal Business Name): MS. NATTAWAN SUWANNIMIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E CECIL AVE
NORTH EAST MD
21901-4057
US

IV. Provider business mailing address

410 W FURROW LN
NEWARK DE
19702-4850
US

V. Phone/Fax

Practice location:
  • Phone: 302-897-2795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32842
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: