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General NPI Number Information
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NPI Number | 1770953747
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Entity Type | Organization
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Legal Business Name | IMANI HOUSE MEDICAL SERVICES
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 4816 LAUREL AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-6402
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Country | US
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Telephone | 443-415-2271
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Fax | 410-664-2951
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Provider Business Mailing Address
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Address Line | 6101 PARK HEIGHTS AVE APT 1D
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City | BALTIMORE
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State | MD
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Zip | 21215-3640
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Country | US
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Telephone | 443-415-3371
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Fax | 410-624-7190
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. ANNETTE YOUVONNE KINGEL
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Credential | DNP FP CRNP
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Telephone | 443-415-3371
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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 |
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License Number State | MD
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