Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | R221458 | MD |
NPI | 1265103089 |
---|---|
Provider Name | Lydia Asafo-Agyei |
First Address | Rosedale, MD 21237-3511 |
Second Address | Rosedale, MD 21237-3511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2021 |
Last Update Date | 22/09/2021 |