Individual
NAUTICA KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 GARRETT AVE, LA PLATA, MD 20646-5960
(301) 609-5400
Mailing address
11117 CANTER CIR, UPPER MARLBORO, MD 20772-8357
(301) 335-9675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R258768
MD
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN500016537
DC
Other
Enumeration date
01/09/2024
Last updated
09/04/2024
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