Provider Demographics
NPI:1972080083
Name:EDMONDS, YALMIKIA N (HAIR LOSS PRACTIONER)
Entity Type:Individual
Prefix:
First Name:YALMIKIA
Middle Name:N
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:HAIR LOSS PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 CARLI CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3806
Mailing Address - Country:US
Mailing Address - Phone:443-274-7381
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 405
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3092
Practice Address - Country:US
Practice Address - Phone:443-274-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4174501744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1744P3200XMedicaid