Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R154292 | MD |
NPI | 1003084237 |
---|---|
Provider Name | Brenda Kay Mathews-Vitello |
First Address | Annapolis, MD 21401-7027 |
Second Address | Annapolis, MD 21401-7027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 27/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R154292 | STATE LICENSE (01) | MD |