| NPI | 1861948853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL RENEE PORTER Owner 410-430-7247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-01-10 |