Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R210280 | MD |
NPI | 1003423385 |
---|---|
Provider Name | Gladys Tombise Ekema |
First Address | Upper Marlboro, MD 20772-3194 |
Second Address | Washington, DC 20010-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2020 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R210280 | MBON (01) | MD |