Provider Demographics
NPI:1316583750
Name:TETTEH, ALFRED (MSN CRNP, NP-C)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:TETTEH
Suffix:
Gender:M
Credentials:MSN CRNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BEL AIR RD STE C1
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2741
Mailing Address - Country:US
Mailing Address - Phone:443-966-3900
Mailing Address - Fax:
Practice Address - Street 1:408 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1601
Practice Address - Country:US
Practice Address - Phone:667-214-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily