Individual
EMEM A IBANGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP-PMH
Contact information
Practice address
5022 CAMPBELL BLVD, NOTTINGHAM, MD 21236-4969
(443) 442-1568
Mailing address
4712 ELSRODE AVE, BALTIMORE, MD 21214-2809
(443) 838-8682
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R156407
MD
Other
Enumeration date
06/17/2019
Last updated
06/17/2019
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