Individual
GLORY TATAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3203A CORPORATE CT, ELLICOTT CITY, MD 21042-2247
(410) 205-2458
Mailing address
3203A CORPORATE CT, ELLICOTT CITY, MD 21042-2247
(410) 696-2645
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
R222480
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R222480
MD
Other
Enumeration date
07/19/2021
Last updated
12/26/2024
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