Individual provider Active NPI

Etietop Ubak

  • Registered Nurse
  • Clinton, MD
National Provider Identifier
1568308328
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R263408 Issued in MD
Practice address
7801 Old Branch Ave
Clinton, MD 20735-1608
Phone
(240) 559-7353
NPI assigned
Apr 24, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X R263408 MD Primary

Addresses

Primary practice location

7801 Old Branch Ave
Clinton, MD 20735-1608

Mailing address

7801 Old Branch Ave Ste 405
Clinton, MD 20735-1644
Phone (240) 559-7353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
R263408MDMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1568308328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7801 OLD BRANCH AVE STE 405",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207351644",
            "telephone_number": "240-559-7353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 OLD BRANCH AVE",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207351608",
            "telephone_number": "240-559-7353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UBAK",
        "first_name": "ETIETOP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-24",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R263408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.