Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | R139139 | MD |
NPI | 1013080647 |
---|---|
Provider Name | Gwynedd Morgwyn Reece |
First Address | Millersville, MD 21108-2519 |
Second Address | Millersville, MD 21108-2519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 07/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MR0903270 | FEDERAL CONTROLLED SUBSTA (01) | MD |
R139139 | NURSE LICENSE (01) | MD |