Provider Demographics
NPI:1043821226
Name:FEREBEE, AYANNA FEMI (LICENSE NURSE)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:FEMI
Last Name:FEREBEE
Suffix:
Gender:F
Credentials:LICENSE NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S GILMOR ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2498
Mailing Address - Country:US
Mailing Address - Phone:443-435-1871
Mailing Address - Fax:
Practice Address - Street 1:111 S GILMOR ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2498
Practice Address - Country:US
Practice Address - Phone:443-435-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP54990163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLP54990Medicaid