Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R206783 | MD |
NPI | 1023517869 |
---|---|
Provider Name | Christine Marie Habersaat |
First Address | Baltimore, MD 21201-4783 |
Second Address | Glen Burnie, MD 21061-5864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 31/05/2019 |