Facts
- Status
- A
- Credential
- PMHNP-BC
- Type
- Individual
- Enumeration date
- 2023-12-01
- Last updated
- 2024-09-08
Licenses
- License MD
- r200004
Location
- Practice location
- 3000 MANCHESTER RD STE B
- City
- MANCHESTER MD
- Postal code
- 211021850
- Phone
- 443-302-9923
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.