Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R218563 | MD |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN1039408 | DC |
NPI | 1033473582 |
---|---|
Provider Name | Gissella Mana |
First Address | Columbia, MD 21044-1915 |
Second Address | Columbia, MD 21044-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 13/10/2020 |