Individual
NICOLE VIRGINIA TENNISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1140 MARLBORO RD, LOTHIAN, MD 20711-9539
(410) 271-5543
Mailing address
1140 MARLBORO RD, LOTHIAN, MD 20711-9539
(410) 271-5543
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
A00087423
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A00087423
BON
MD
Enumeration date
06/15/2021
Last updated
06/15/2021
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