Provider Demographics
NPI:1720172547
Name:KYEREMATEN, SOPHIA (CNM)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KYEREMATEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:BOETENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3001 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1189
Mailing Address - Country:US
Mailing Address - Phone:301-618-2355
Mailing Address - Fax:301-618-3521
Practice Address - Street 1:7582 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1744
Practice Address - Country:US
Practice Address - Phone:301-618-1550
Practice Address - Fax:301-429-1873
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR116128367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420000213Medicaid
MD420000213Medicaid
S42834Medicare UPIN