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General NPI Number Information
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NPI Number | 1578200119
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Entity Type | Organization
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Legal Business Name | E.P.I, LLC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 4712 ELSRODE AVE
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City | BALTIMORE
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State | MD
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Zip | 21214-2809
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Country | US
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Telephone | 443-838-8682
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Fax | 443-836-2576
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Provider Business Mailing Address
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Address Line | 4712 ELSRODE AVE
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City | BALTIMORE
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State | MD
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Zip | 21214-2809
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Country | US
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Telephone | 443-838-8682
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Fax | 443-836-2576
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Authorized Official
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Title or Position | OWNER
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Name | EMEM IBANGA
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Credential | NP
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Telephone | 443-838-8682
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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 |
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License Number State |
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