Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R196577 | MD |
NPI | 1003433285 |
---|---|
Provider Name | Mrs. Ija Lynn Delia |
First Address | Baltimore, MD 21228-4873 |
Second Address | Catonsville, MD 21228-3632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2020 |
Last Update Date | 03/07/2020 |