Individual
MARYAM NISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 N CHARLES ST, TOWSON, MD 21204-6808
(443) 370-3084
Mailing address
6701 N CHARLES ST, TOWSON, MD 21204-6808
(443) 370-3084
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R196002
MD
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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