Healthcare Provider Details

I. General information

NPI: 1861751570
Provider Name (Legal Business Name): EDWIN NTUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 CASTLE BLVD APT 1000
SILVER SPRING MD
20904-4643
US

IV. Provider business mailing address

14000 CASTLE BLVD APT 1000
SILVER SPRING MD
20904-4643
US

V. Phone/Fax

Practice location:
  • Phone: 240-704-0801
  • Fax: 240-641-8390
Mailing address:
  • Phone: 240-704-0801
  • Fax: 240-641-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR213189
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: