Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R029702 | MD |
NPI | 1003869322 |
---|---|
Provider Name | Gail Patricia Nuetzel |
First Address | Towson, MD 21204-6800 |
Second Address | Towson, MD 21204-6800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MN1027350 | DEA LICENSE (01) | |
N55585 | CDS LICENSE (01) | MD |
R029702 | STATE LICENSE (01) | MD |