Individual
AIESHA J WACTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
600 N WOLFE ST, CARNEGIE 136, BALTIMORE, MD 21287-0005
(443) 287-8288
Mailing address
600 NORTH WOLFE STREET, PHIPPS, SUITE 351, BALTIMORE, MD 21287
(410) 614-1620
(410) 614-0376
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R216317
MD
363LG0600X
Gerontology Nurse Practitioner
R216317
MD
Other
Enumeration date
09/10/2015
Last updated
10/05/2018
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