Provider Demographics
NPI:1013452101
Name:ANSAH-LARBI, FREDA (DNP)
Entity Type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:ANSAH-LARBI
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18216 MERINO DR
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3292
Mailing Address - Country:US
Mailing Address - Phone:240-581-0125
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 540
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3112
Practice Address - Country:US
Practice Address - Phone:301-686-1665
Practice Address - Fax:301-686-1779
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD240050200Medicaid