Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R235309 | MD |
NPI | 1104585629 |
---|---|
Provider Name | Alicia M Sacks |
First Address | Baltimore, MD 21204 |
Second Address | Baltimore, MD 21204-6881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 13/12/2021 |