Individual
MISS IVANNA PLYMOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7503 SURRATTS RD, CLINTON, MD 20735-3358
(301) 877-4656
Mailing address
2090 ARBROTH CT, WALDORF, MD 20601-3787
(252) 268-2608
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
5010033
NC
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
5010033
NC
Other
Enumeration date
10/26/2017
Last updated
08/23/2023
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