Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R176670 | MD |
NPI | 1003560566 |
---|---|
Provider Name | Ms. Gloria Asiamah Fosu |
First Address | Burtonsville, MD 20866-1022 |
Second Address | Burtonsville, MD 20866-1022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 03/02/2022 |