Provider Demographics
NPI:1073063632
Name:ROSS-ANYASO, TAMIEKO (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMIEKO
Middle Name:
Last Name:ROSS-ANYASO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5919 LEBANON LN
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5142
Mailing Address - Country:US
Mailing Address - Phone:410-382-5386
Mailing Address - Fax:
Practice Address - Street 1:5919 LEBANON LN
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5142
Practice Address - Country:US
Practice Address - Phone:410-382-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183031305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization