Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R117061 | MD |
NPI | 1023150463 |
---|---|
Provider Name | Ms. Tammy Michelle Slater |
First Address | Forest Hill, MD 21050-2537 |
Second Address | Baltimore, MD 21287-0005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P05730 | (02) | MD |