Provider Demographics
NPI:1295471373
Name:BOATENG, FREDA (CRNP, FNP)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:BOATENG
Suffix:
Gender:F
Credentials:CRNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 SULPHUR SPRING RD STE 109
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:443-575-4880
Mailing Address - Fax:443-575-4891
Practice Address - Street 1:1205 YORK RD STE 26
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:410-532-1640
Practice Address - Fax:410-321-5787
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily