Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R196399 | MD |
NPI | 1003200791 |
---|---|
Provider Name | Caitlin Marie Averill |
First Address | Reisterstown, MD 21136-1229 |
Second Address | Reisterstown, MD 21136-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 20/03/2015 |