Individual
HA LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 BOYLES ST, FREDERICK, MD 21702-9242
(301) 846-1096
Mailing address
160 RITCHIE HWY, SEVERNA PARK, MD 21146-1120
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R201437
MD
Other
Enumeration date
10/08/2020
Last updated
10/01/2024
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