Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R149679 | MD |
NPI | 1033346200 |
---|---|
Provider Name | Ms. Caroline Fidyk Pratz |
First Address | Baltimoe, MD 21231 |
Second Address | Baltimoe, MD 21231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 23/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
419806900 | (05) | MD |