MEDICARE: DR. ELIZABETH EBEI NDIKA CRNP/ FNP-C, PMHNP-

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	R151225	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R151225	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730565599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH EBEI NDIKA CRNP/ FNP-C, PMHNP-

Provider Business Mailing Address
First Line	:	14333 LAUREL BOWIE RD STE 204
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1179
Country	:	US
Telephone Number	:	240-241-4989
Fax Number	:	301-477-1976

Provider Business Practice Location Address
First Line	:	14333 LAUREL BOWIE RD STE 204
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1179
Country	:	US
Telephone Number	:	240-241-4989
Fax Number	:	301-477-1976

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	09/13/2023

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