Individual
TELISSA MACKALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8930 STANFORD BLVD, COLUMBIA, MD 21045-5805
(443) 285-0807
Mailing address
8930 STANFORD BLVD, COLUMBIA, MD 21045-5805
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP46362
MD
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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