Provider Demographics
NPI:1104467414
Name:BAIDOO, KHADEJA QUBLA IBN (CRNP)
Entity type:Individual
Prefix:
First Name:KHADEJA
Middle Name:QUBLA IBN
Last Name:BAIDOO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 MARSDEN PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6822
Mailing Address - Country:US
Mailing Address - Phone:571-275-6765
Mailing Address - Fax:
Practice Address - Street 1:4843 MARSDEN PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6822
Practice Address - Country:US
Practice Address - Phone:571-275-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214238163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse