Provider Demographics
NPI:1790328268
Name:EGIEFAMEH, CHRISTIANAH BOSEDE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANAH
Middle Name:BOSEDE
Last Name:EGIEFAMEH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 COMMONWEALTH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3044
Mailing Address - Country:US
Mailing Address - Phone:410-514-6718
Mailing Address - Fax:
Practice Address - Street 1:3107 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1719
Practice Address - Country:US
Practice Address - Phone:410-869-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209071363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD658022000Medicaid