Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R235085 | MD |
NPI | 1124773767 |
---|---|
Provider Name | Jennifer Leigh Rothenberg |
First Address | Columbia, MD 21045-2570 |
Second Address | Towson, MD 21204-6808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2022 |
Last Update Date | 11/02/2022 |