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General NPI Number Information
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NPI Number | 1205343498
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Entity Type | Individual
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Provider Name | MARY FOWAAH BOATENG DNP, FNP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 800 S FREDERICK AVE STE 208
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4152
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Country | US
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Telephone | 301-679-5770
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Fax | 301-235-1520
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Provider Business Mailing Address
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Address Line | 800 S FREDERICK AVE STE 208
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4152
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Country | US
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Telephone | 301-679-5770
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Fax | 301-235-1520
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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 | R214992
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License Number State | MD
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