Provider Demographics
NPI:1215217443
Name:YOMB, MOISE (PMHNP)
Entity Type:Individual
Prefix:
First Name:MOISE
Middle Name:
Last Name:YOMB
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 BELAIR RD STE 200-202
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1103
Mailing Address - Country:US
Mailing Address - Phone:410-513-7577
Mailing Address - Fax:
Practice Address - Street 1:9712 BELAIR RD STE 200-202
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1103
Practice Address - Country:US
Practice Address - Phone:410-513-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty