Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R104305 | MD |
NPI | 1558343236 |
---|---|
Provider Name | Melissa Donelson |
First Address | Glen Burnie, MD 21061-6902 |
Second Address | Glen Burnie, MD 21061-5803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 29/10/2020 |