Healthcare Provider Details

I. General information

NPI: 1063019925
Provider Name (Legal Business Name): NAA DEDE OWUSU KWARTENG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MERIDIAN HILL WAY
UPPER MARLBORO MD
20772-4068
US

IV. Provider business mailing address

10920 MERIDIAN HILL WAY
UPPER MARLBORO MD
20772-4068
US

V. Phone/Fax

Practice location:
  • Phone: 571-354-9433
  • Fax: 301-786-3996
Mailing address:
  • Phone: 571-354-9433
  • Fax: 301-786-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024180059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: