Provider Demographics
NPI:1902596745
Name:TIO, NORAH JEMUTAI
Entity Type:Individual
Prefix:
First Name:NORAH
Middle Name:JEMUTAI
Last Name:TIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 VALENTINE WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2363
Mailing Address - Country:US
Mailing Address - Phone:952-992-9162
Mailing Address - Fax:
Practice Address - Street 1:6011 VALENTINE WAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2363
Practice Address - Country:US
Practice Address - Phone:952-992-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005449363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health