Provider Demographics
NPI:1215304977
Name:MOTARI MOKAYA, ANGELINE (CRNP)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:MOTARI MOKAYA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANGELINE
Other - Middle Name:
Other - Last Name:MOTARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-732-8800
Mailing Address - Fax:443-703-3242
Practice Address - Street 1:3120 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1720
Practice Address - Country:US
Practice Address - Phone:410-558-4800
Practice Address - Fax:410-675-8947
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily