Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R177472 | MD |
NPI | 1033618343 |
---|---|
Provider Name | Alice A. Mirzaie |
First Address | Baltimore, MD 21202-2102 |
Second Address | Baltimore, MD 21202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 02/02/2018 |