MEDICARE: MS. LAURETTE ETAKA ABUNAW PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R221410	MD

General Provider Information

NPI Number	:	1659968642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURETTE ETAKA ABUNAW PMHNP-BC

Provider Business Mailing Address
First Line	:	5457 TWIN KNOLLS RD STE 300N17
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3259
Country	:	US
Telephone Number	:	443-991-0090
Fax Number	:	443-545-7795

Provider Business Practice Location Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	443-991-0090
Fax Number	:	443-545-7795

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

Provider Enumeration Date	:	12/24/2020
Last Update Date	:	12/16/2025

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