Healthcare Provider Details

I. General information

NPI: 1861904039
Provider Name (Legal Business Name): LAWRENDA AFFUL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 REISTERSTOWN RD STE 104B
OWINGS MILLS MD
21117-4513
US

IV. Provider business mailing address

9199 REISTERSTOWN RD STE 104B
OWINGS MILLS MD
21117-4513
US

V. Phone/Fax

Practice location:
  • Phone: 614-772-7789
  • Fax:
Mailing address:
  • Phone: 614-772-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR253276
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.163832.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: