MEDICARE: MS. EBONY JOI CROSS CRNP-PMH

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	R221761	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R221761	MD

General Provider Information

NPI Number	:	1508303801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EBONY JOI CROSS CRNP-PMH

Provider Business Mailing Address
First Line	:	2670 CRAIN HWY STE 510
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 CRAIN HWY STE 510
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2819
Country	:	US
Telephone Number	:	301-374-8772
Fax Number	:

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

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	07/07/2022

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