Individual
MRS. LACREASHA FULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP-PMH
Contact information
Practice address
9649 BELAIR RD STE 104, NOTTINGHAM, MD 21236-1117
(410) 529-1309
(410) 529-1005
Mailing address
9649 BELAIR RD STE 104, NOTTINGHAM, MD 21236-1117
(410) 529-1309
(410) 529-1005
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R219476
MD
Other
Enumeration date
10/09/2020
Last updated
08/08/2023
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