Individual
MRS. LISA LINN SANTO DOMINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP-PEDIATRICS
Contact information
Practice address
600 N WOLFE ST, BRADY 320, BALTIMORE, MD 21287-0005
(410) 955-8769
(410) 955-1464
Mailing address
600 N WOLFE ST, BRADY 320, BALTIMORE, MD 21287-0005
(410) 955-8769
(410) 955-1464
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R175012
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027626000
—
MD
Enumeration date
04/24/2008
Last updated
08/10/2012
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