Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AC004015 | MD |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN230900 | GA |
NPI | 1003495557 |
---|---|
Provider Name | Pearl Rose Rucker |
First Address | Baltimore, MD 21236-4067 |
Second Address | Baltimore, MD 21236-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2021 |
Last Update Date | 01/12/2021 |