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General NPI Number Information
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NPI Number | 1609368752
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Entity Type | Individual
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Provider Name | ROBERTA Y ACKOM CNM
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Gender | Female
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 11890 HEALING WAY
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City | SILVER SPRING
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State | MD
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Zip | 20904-7917
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Country | US
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Telephone | 240-637-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4370 VARNUM PL NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2101
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Country | US
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Telephone | 301-275-9459
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 0024177823
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | R202083
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License Number State | MD
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