Healthcare Provider Details

I. General information

NPI: 1609794965
Provider Name (Legal Business Name): LEILANI LIM PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 CORPORATE DR STE C
NOTTINGHAM MD
21236-4917
US

IV. Provider business mailing address

8019 CORPORATE DR STE C
NOTTINGHAM MD
21236-4917
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-7952
  • Fax: 410-701-3845
Mailing address:
  • Phone: 410-505-7952
  • Fax: 410-701-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR159617
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: