Provider Demographics
NPI:1154092716
Name:WAMBAA, YVONNE (APRN)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:WAMBAA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FREDERICK RD STE 162
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4646
Mailing Address - Country:US
Mailing Address - Phone:443-637-1002
Mailing Address - Fax:
Practice Address - Street 1:405 FREDERICK RD STE 162
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4646
Practice Address - Country:US
Practice Address - Phone:443-637-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health