Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R175046 | MD |
NPI | 1013336114 |
---|---|
Provider Name | Ingrid Halvorson |
First Address | Baltimore, MD 21297-3086 |
Second Address | Frederick, MD 21702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 15/05/2019 |