Healthcare Provider Details

I. General information

NPI: 1881848950
Provider Name (Legal Business Name): SONNIE K OWUSU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONNIE C KEKULAH

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 OLD COURT RD STE 300
RANDALLSTOWN MD
21133-5100
US

IV. Provider business mailing address

273 DORSET ST
BROOKLYN NY
11236-1411
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-7337
  • Fax: 410-521-7377
Mailing address:
  • Phone: 718-629-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR221924
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: