Healthcare Provider Details

I. General information

NPI: 1407633274
Provider Name (Legal Business Name): ANITA UCHE AKEWUSOLA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 MOUNTAIN RD STE 101
PASADENA MD
21122-7202
US

IV. Provider business mailing address

2528 MOUNTAIN RD STE 101
PASADENA MD
21122-7202
US

V. Phone/Fax

Practice location:
  • Phone: 443-798-7778
  • Fax:
Mailing address:
  • Phone: 443-798-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08230873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: