Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AC004001 | MD |
NPI | 1194494500 |
---|---|
Provider Name | Ms. Ana Isabel Arevalo |
First Address | Washington, DC 20007-2137 |
Second Address | Baltimore, MD 21239-2945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2021 |
Last Update Date | 17/11/2021 |