Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | R090984 | MD |
N | 363LA2200X | Nurse Practitioner - Adult Health | R090984 | MD |
NPI | 1013987395 |
---|---|
Provider Name | Mrs. Beth Ann Martucci |
First Address | Laurel, MD 20723-5719 |
Second Address | Baltimore, MD 21224-5238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P69701 | (02) | MD |