Provider Demographics
NPI:1134914567
Name:NIAMKEY-EDIEMOU, TANIA GERTRUDE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:GERTRUDE
Last Name:NIAMKEY-EDIEMOU
Suffix:
Gender:
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4518
Mailing Address - Country:US
Mailing Address - Phone:240-355-1475
Mailing Address - Fax:
Practice Address - Street 1:2641 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4518
Practice Address - Country:US
Practice Address - Phone:240-355-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2104752084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine