MEDICARE: MRS. MERCY VIATOR CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R181866	MD

General Provider Information

NPI Number	:	1467914077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERCY VIATOR CRNP

Provider Business Mailing Address
First Line	:	7671 QUARTERFIELD RD STE 200
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4407
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

Provider Business Practice Location Address
First Line	:	7671 QUARTERFIELD RD STE 200
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4407
Country	:	US
Telephone Number	:	410-766-0111
Fax Number	:	410-582-9155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	03/22/2023

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