Individual
MRS. DIANA LEE NICOLAISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
791 AQUAHART RD, SUITE 200, GLEN BURNIE, MD 21061-3961
(410) 222-6625
(410) 222-6679
Mailing address
791 AQUAHART RD, SUITE 200, GLEN BURNIE, MD 21061-3961
(410) 222-6625
(410) 222-6679
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RO85571
MD
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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