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General NPI Number Information
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NPI Number | 1609617703
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Entity Type | Individual
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Provider Name | PATRICIA MAFORNGWAHFOR TALA
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 9135 PISCATAWAY RD STE 410
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City | CLINTON
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State | MD
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Zip | 20735-2555
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Country | US
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Telephone | 240-643-1063
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Fax |
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Provider Business Mailing Address
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Address Line | 10203 BIRDIE LN
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-6068
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Country | US
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Telephone | 240-486-2745
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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 | R224410
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License Number State | MD
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