Healthcare Provider Details

I. General information

NPI: 1609330356
Provider Name (Legal Business Name): AMBER ROSE OKUBO CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMBER ROSE CANTY

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 REGENCY PL STE 201
WHITE PLAINS MD
20695-3074
US

IV. Provider business mailing address

2301 FOREST RIDGE TER
CHESAPEAKE BEACH MD
20732-4678
US

V. Phone/Fax

Practice location:
  • Phone: 301-638-7802
  • Fax: 301-638-7805
Mailing address:
  • Phone: 757-593-7423
  • Fax: 301-856-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR216474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: