Peniel Interventional Care
Nurse Practitioner, Psych/Mental Health in Joppa, MD. Organization (NPI-2).
NPI number1962234849
StatusActive
Last updated in NPPESAug 19, 2024
Details
- NPI
- 1962234849
- Entity type
- Organization (NPI-2)
- Legal business name
- Peniel Interventional Care
- Organization subpart
- No
- Enumeration date
- Aug 19, 2024
- Certification date
- Aug 19, 2024
- Last updated
- Aug 19, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
Practice location
318 Spry Island RdJoppa, MD 21085-5424
Phone 317-797-9816
Mailing address
318 Spry Island RdJoppa, MD 21085-5424
Phone 317-797-9816
Authorized official
Elsie Antwiwaa Tweneboah-Koduah
Co-Owner
6674346218
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