Healthcare Provider Details

I. General information

NPI: 1336715416
Provider Name (Legal Business Name): SETH OWUSU-KWARTENG CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

10920 MERIDIAN HILL WAY
UPPER MARLBORO MD
20772-4068
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-4689
  • Fax:
Mailing address:
  • Phone: 301-523-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR210600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: