Healthcare Provider Details

I. General information

NPI: 1811581085
Provider Name (Legal Business Name): MICHELLE DANIELLE DENNIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 SECURITY BLVD STE 100-B39
BALTIMORE MD
21207-5173
US

IV. Provider business mailing address

6340 SECURITY BLVD STE 100-B39
BALTIMORE MD
21207-5173
US

V. Phone/Fax

Practice location:
  • Phone: 410-907-0622
  • Fax: 667-239-1001
Mailing address:
  • Phone: 410-907-0622
  • Fax: 667-239-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR205856
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: