Individual
MS. REBECCA ALIZA THEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1645 LIBERTY RD STE 205, ELDERSBURG, MD 21784-6542
(203) 481-7008
Mailing address
3911 N CHARLES ST, BALTIMORE, MD 21218-1733
(917) 613-0606
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R226346
MD
Other
Enumeration date
07/02/2015
Last updated
08/22/2023
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