Healthcare Provider Details

I. General information

NPI: 1386692960
Provider Name (Legal Business Name): HEATHER S TRAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DEFENSE HWY SUITE 210
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

122 DEFENSE HWY SUITE 210
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-9694
  • Fax: 410-266-9695
Mailing address:
  • Phone: 410-266-9694
  • Fax: 410-266-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR131937
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR131937
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: