Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R198223 | MD |
NPI | 1073059309 |
---|---|
Provider Name | Gifty Yeboah |
First Address | Rockville, MD 20852 |
Second Address | Rockville, MD 20852-3142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 28/06/2017 |