Provider Demographics
NPI:1982117388
Name:BAFFOE-BONNIE, EDNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:BAFFOE-BONNIE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 DARK STAR WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4743
Mailing Address - Country:US
Mailing Address - Phone:215-880-7421
Mailing Address - Fax:
Practice Address - Street 1:4700 DARK STAR WAY
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4743
Practice Address - Country:US
Practice Address - Phone:215-880-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2017020880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily