Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R184959 | MD |
NPI | 1003437377 |
---|---|
Provider Name | Judith Tangi |
First Address | Laurel, MD 20724-2967 |
Second Address | Laurel, MD 20724-2967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2020 |
Last Update Date | 28/04/2020 |