Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R089910 | MD |
NPI | 1013064799 |
---|---|
Provider Name | Mrs. Jessica Lake Buhr |
First Address | Ellicott City, MD 21042-7806 |
Second Address | Greenbelt, MD 20770-2250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 26/01/2021 |