Provider Demographics
NPI:1548871106
Name:GWANYEBIT, MUNI
Entity type:Individual
Prefix:
First Name:MUNI
Middle Name:
Last Name:GWANYEBIT
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 1:8605 OTTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1985
Mailing Address - Country:US
Mailing Address - Phone:301-204-6086
Mailing Address - Fax:
Practice Address - Street 1:13994 BALTIMORE AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5087
Practice Address - Country:US
Practice Address - Phone:240-491-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208398363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health