Healthcare Provider Details

I. General information

NPI: 1629624887
Provider Name (Legal Business Name): NYEINPU WOAH-TEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OWINGS CT
REISTERSTOWN MD
21136-6428
US

IV. Provider business mailing address

1251 E BELVEDERE AVE
BALTIMORE MD
21239-2602
US

V. Phone/Fax

Practice location:
  • Phone: 443-273-3723
  • Fax:
Mailing address:
  • Phone: 410-206-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR207528
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: