Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | R165733 | MD |
NPI | 1073050365 |
---|---|
Provider Name | Marla Brown |
First Address | Baltimore, MD 21215-1434 |
Second Address | Baltimore, MD 21215-1434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |