Provider Demographics
NPI:1073059309
Name:YEBOAH, GIFTY
Entity Type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GIFTY
Other - Middle Name:
Other - Last Name:OFORI-ATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11125 ROCKVILLE PIKE #110
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-984-3100
Mailing Address - Fax:301-984-3130
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 110
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-984-3100
Practice Address - Fax:301-984-3130
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198223163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse