| Practistat | |
|
5457 Twin Knolls Rd Ste 300 Columbia MD 21045-3296 | |
| (240) 461-9005 | |
| Not Available |
| Full Name | Practistat |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 5457 Twin Knolls Rd Ste 300, Columbia, Maryland |
| Authorized Official Name and Position | Muniratu Fabode (OWNER) |
| Authorized Official Contact | 2404619005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Practistat 5457 Twin Knolls Rd Ste 300 Columbia MD 21045-3296 Ph: (240) 461-9005 | Practistat 5457 Twin Knolls Rd Ste 300 Columbia MD 21045-3296 Ph: (240) 461-9005 |
| NPI Number | 1972230639 |
|---|---|
| Provider Enumeration Date | 08/03/2022 |
| Last Update Date | 08/03/2022 |
| Medicare PECOS PAC ID | 2961861653 |
|---|---|
| Medicare Enrollment ID | O20230628002611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972230639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Muniratu Fabode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851055065 PECOS PAC ID: 5092108282 Enrollment ID: I20220211000022 |
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