Individual
MS. CARMEN SUSANNE LICAVOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN-BC
Contact information
Practice address
10 N GREENE ST, BALTIMORE, MD 21201-1524
(410) 605-7000
Mailing address
603 CAPTAIN JOHN BRICE WAY, ANNAPOLIS, MD 21401-6327
(313) 819-2541
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704185653
MI
363LA2200X
Adult Health Nurse Practitioner
Primary
R189866
MD
Other
Enumeration date
07/04/2006
Last updated
10/02/2012
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