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General NPI Number Information
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NPI Number | 1134680648
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Entity Type | Individual
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Provider Name | ELSIE ANTWIWAA TWENEBOAH-KODUAH DNP,CRNP,PMHNP
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 317 SPRY ISLAND RD
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City | JOPPA
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State | MD
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Zip | 21085-5425
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Country | US
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Telephone | 667-434-6218
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Fax |
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Provider Business Mailing Address
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Address Line | 318 SPRY ISLAND RD
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City | JOPPA
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State | MD
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Zip | 21085-5424
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Country | US
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Telephone | 317-797-9816
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R209129
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License Number State | MD
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