MEDICARE: MRS. YATA HAJA BAZZIE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN199031	MD

General Provider Information

NPI Number	:	1043888779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YATA HAJA BAZZIE FNP

Provider Business Mailing Address
First Line	:	9409 STREAM VALLEY LN
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-1924
Country	:	US
Telephone Number	:	240-475-4161
Fax Number	:	240-318-2001

Provider Business Practice Location Address
First Line	:	9409 STREAM VALLEY LN
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-1924
Country	:	US
Telephone Number	:	240-475-4161
Fax Number	:	240-318-2001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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