Individual
MARY A RACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
10155 YORK RD, STE 200, COCKEYSVILLE, MD 21030-3352
(410) 628-2026
(410) 628-6507
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RO77166
MD
363LA2200X
Adult Health Nurse Practitioner
Primary
R017766
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246581700
—
MD
Enumeration date
10/23/2006
Last updated
03/24/2023
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