Healthcare Provider Details

I. General information

NPI: 1982117388
Provider Name (Legal Business Name): EDNA BAFFOE-BONNIE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 DARK STAR WAY
OWINGS MILLS MD
21117-4743
US

IV. Provider business mailing address

4700 DARK STAR WAY
OWINGS MILLS MD
21117-4743
US

V. Phone/Fax

Practice location:
  • Phone: 215-880-7421
  • Fax:
Mailing address:
  • Phone: 215-880-7421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017020880
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR185475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: