Individual
MRS. VICTORIA LEEANNE MACQUILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 N CAROLINE ST, BALTIMORE, MD 21287-0006
(410) 955-5000
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6421
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R215171
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R215171
LICENSE
MD
Enumeration date
04/28/2021
Last updated
09/29/2021
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