Provider Demographics
NPI:1750641221
Name:AMENE, ERIC ANGEME (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANGEME
Last Name:AMENE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14240 W SIDE BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6237
Mailing Address - Country:US
Mailing Address - Phone:443-803-4837
Mailing Address - Fax:
Practice Address - Street 1:4201 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3305
Practice Address - Country:US
Practice Address - Phone:410-764-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health