Healthcare Provider Details

I. General information

NPI: 1588904080
Provider Name (Legal Business Name): MARILYN R WELLING ANCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN SMIRAGLIA ANCC

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5479
  • Fax:
Mailing address:
  • Phone: 410-601-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR035876
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: