Healthcare Provider Details

I. General information

NPI: 1194364588
Provider Name (Legal Business Name): CYNTHIA EKWUTIFE DNP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 02/20/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GIFTS MENTAL HEALTH CLINIC 20 CROSSROADS DRIVE SUITE 105
OWINGS MILLS MD
21117-2111
US

IV. Provider business mailing address

2504 HIGHCREST CT
MANCHESTER MD
21102-1413
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-2007
  • Fax:
Mailing address:
  • Phone: 443-895-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR197853
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR197853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: