Provider Demographics
NPI:1275894503
Name:NTUMAZAH, MABI T
Entity Type:Individual
Prefix:
First Name:MABI
Middle Name:T
Last Name:NTUMAZAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CRAIN HWY S STE 3
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3657
Mailing Address - Country:US
Mailing Address - Phone:410-595-6199
Mailing Address - Fax:410-684-5334
Practice Address - Street 1:420 CRAIN HWY S STE 3
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3657
Practice Address - Country:US
Practice Address - Phone:410-595-6199
Practice Address - Fax:410-684-5334
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1029326163W00000X
MDR205083163W00000X, 363LP0808X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide