Individual
AMY THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
103 COOL SPRINGS RD, NORTH EAST, MD 21901-2902
(410) 322-2265
Mailing address
500 UPPER CHESAPEAKE DR, BEL AIR, MD 21014-4324
(443) 643-1000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R165542
MD
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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