Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R066301 | MD |
NPI | 1124123542 |
---|---|
Provider Name | Ms. Susan Brown |
First Address | Baltimore, MD 21279-0035 |
Second Address | Towson, MD 21204-7700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |