Organization Name: | METRO REACH BEHAVIORAL HEALTH |
NPI Number: | 1336503317 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ABIMBOLA RUNSEWE (NURSE PRACTITIONER) |
Mailing Address: | 3608 Milford Mill Rd Windsor Mill |
State: | MD US |
Postal Code: | 212443328 |
Phone Number: | 4434057135 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2016 |
NPI Last Update Date: | 04/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |