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General NPI Number Information
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NPI Number | 1003423385
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Entity Type | Individual
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Provider Name | GLADYS TOMBISE EKEMA MOSASO PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 7120 MINSTREL WAY SUITE 203
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City | COLUMBIA
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State | MD
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Zip | 21045-5292
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Country | US
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Telephone | 508-979-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 9201 EDGEWORTH DR UNIT 3412
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20791-7505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R210280
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License Number State | MD
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