Provider Demographics
NPI:1295289916
Name:MYNP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MYNP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UMAR-KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:804-937-3219
Mailing Address - Street 1:1817 BELLAMY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8002
Mailing Address - Country:US
Mailing Address - Phone:804-937-3219
Mailing Address - Fax:
Practice Address - Street 1:5802 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2075
Practice Address - Country:US
Practice Address - Phone:804-937-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001787261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care