Provider Demographics
NPI:1679367379
Name:IBRAHIM, RAMATU (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:RAMATU
Middle Name:
Last Name:IBRAHIM
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 1:12600 IVORY PASS
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2442
Mailing Address - Country:US
Mailing Address - Phone:571-244-1436
Mailing Address - Fax:
Practice Address - Street 1:12600 IVORY PASS
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2442
Practice Address - Country:US
Practice Address - Phone:571-244-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205339363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner