Provider Demographics
NPI:1003560566
Name:FOSU, GLORIA ASIAMAH (RN, MSN, PMHMP-BC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ASIAMAH
Last Name:FOSU
Suffix:
Gender:F
Credentials:RN, MSN, PMHMP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 GREENVIEW DR STE 455
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3287
Mailing Address - Country:US
Mailing Address - Phone:240-752-4513
Mailing Address - Fax:949-577-4067
Practice Address - Street 1:14502 GREENVIEW DR SUIT 455
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2070
Practice Address - Country:US
Practice Address - Phone:240-752-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176670363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health