Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R114538 | MD |
NPI | 1003167420 |
---|---|
Provider Name | Mrs. Tamara Jeanne Setola |
First Address | Baltimore, MD 21244-2419 |
Second Address | Baltimore, MD 21244-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 03/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1992794051 | GROUP NPI NUMBER (01) | MD |