Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R172477 | MD |
NPI | 1023462702 |
---|---|
Provider Name | Sridevi Praveen |
First Address | Linthicum, MD 21090-2917 |
Second Address | Elkridge, MD 21075-6198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 24/06/2016 |