| NPI | 1548898265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN SMITH Credentialing Specialist 410-321-0166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2024-04-07 |