Individual
MICHELE H COOTAUCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Mailing address
9910 FRANKLIN SQUARE DR STE 2110, BALTIMORE, MD 21236-4902
(410) 933-6423
(410) 933-1390
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R103929
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
574001100
—
MD
Enumeration date
11/14/2006
Last updated
11/07/2017
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