Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R193082 | MD |
NPI | 1013536960 |
---|---|
Provider Name | Philomena Nufunkuen Keli |
First Address | Burtonsville, MD 20866-2211 |
Second Address | Burtonsville, MD 20866-2211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 10/04/2020 |