Healthcare Provider Details

I. General information

NPI: 1093346124
Provider Name (Legal Business Name): PHYLICIA ANNE FRIEDA NLEND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 222
ANNAPOLIS MD
21401-1073
US

IV. Provider business mailing address

600 RIDGELY AVE STE 130
ANNAPOLIS MD
21401-1045
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax:
Mailing address:
  • Phone: 410-266-8049
  • Fax: 410-266-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC07392
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: