Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R221808 | MD |
NPI | 1174182935 |
---|---|
Provider Name | Miss Yana Boheyna Felix |
First Address | Baltimore, MD 21209-2855 |
Second Address | Baltimore, MD 21287-0010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 06/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R221803 | MARYLAND STATE NEONATAL CRNP LICENSE (01) | MD |