Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R191478 | MD |
NPI | 1013360387 |
---|---|
Provider Name | Mrs. Joanne Elizabeth Desmond |
First Address | Lutherville, MD 21093-4515 |
Second Address | Lutherville, MD 21093-4515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 21/07/2016 |