Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Feb 10, 2012
License(s)
R180980 (MD)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 12123 QUADRILLE LN | Bowie, MD 20720-4384 | 240-646-4985 |
| MAILING | 2250 HICKORY RD | Plymouth Meeting, PA 19462-1047 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.