Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R178902 | MD |
NPI | 1003179805 |
---|---|
Provider Name | Christina Fang |
First Address | Baltimore, MD 21208-6391 |
Second Address | Baltimore, MD 21208-6391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/06/2012 |