Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R202772 | MD |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R202772 | MD |
NPI | 1013395474 |
---|---|
Provider Name | Cara Reske |
First Address | Dundalk, MD 21222-3212 |
Second Address | Dundalk, MD 21222-3212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339517100 | (05) | MD |