Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | LP-0010374 | DE |
N | 363L00000X | Nurse Practitioner | R193259 | MD |
Y | 363LP2300X | Nurse Practitioner - Primary Care | R193259 | MD |
NPI | 1063909398 |
---|---|
Provider Name | John A Hancock |
First Address | Salisbury, MD 21802-3177 |
Second Address | Berlin, MD 21811-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 04/08/2020 |