Healthcare Provider Details

I. General information

NPI: 1922195049
Provider Name (Legal Business Name): MAUREEN B FAMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14809 PENNFIELD CIR
SILVER SPRING MD
20906
US

IV. Provider business mailing address

14629 PEACH ORCHARD RD
SILVER SPRING MD
20905-4437
US

V. Phone/Fax

Practice location:
  • Phone: 301-989-0143
  • Fax:
Mailing address:
  • Phone: 301-989-0143
  • Fax: 301-989-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRO48887
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRO48887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: