Provider Demographics
NPI:1235900440
Name:SEBO, ANDREA BOGNANNI (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BOGNANNI
Last Name:SEBO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 WHITEFORD RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-1506
Mailing Address - Country:US
Mailing Address - Phone:410-688-0615
Mailing Address - Fax:
Practice Address - Street 1:120 S HAYS ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3615
Practice Address - Country:US
Practice Address - Phone:410-688-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner