Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R169252 | MD |
NPI | 1043502545 |
---|---|
Provider Name | Kristen Johnson Reeb |
First Address | Baltimore, MD 21209-1138 |
Second Address | Baltimore, MD 21231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 03/05/2011 |