Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | R164990 | MD |
NPI | 1043426885 |
---|---|
Provider Name | Ms. Rebecca M Damore |
First Address | Annapolis, MD 21403-4211 |
Second Address | Davidsonville, MD 21035-1228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |