Individual
MRS. LANA MARIE ENRIQUEZ BASTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3720 FARRAGUT AVE STE 103, KENSINGTON, MD 20895-2110
(240) 900-3933
Mailing address
3720 FARRAGUT AVE STE 103, KENSINGTON, MD 20895-2110
(240) 900-3933
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024175605
VA
363LF0000X
Family Nurse Practitioner
Primary
AC003089
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC003089
MARYLAND NP LICENSE
MD
Enumeration date
03/14/2018
Last updated
06/07/2021
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