Provider Demographics
NPI:1073059309
Name:YEBOAH, GIFTY
Entity type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:YEBOAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:GIFTY
Other - Middle Name:
Other - Last Name:OFORI-ATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9428 SINGLETON PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7838
Mailing Address - Country:US
Mailing Address - Phone:240-801-2860
Mailing Address - Fax:301-662-6943
Practice Address - Street 1:700 MONTCLAIRE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4577
Practice Address - Country:US
Practice Address - Phone:240-801-2860
Practice Address - Fax:301-662-6943
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198223163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse