Healthcare Provider Details

I. General information

NPI: 1093558918
Provider Name (Legal Business Name): ANDREA BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WILKENS AVE
BALTIMORE MD
21229-5072
US

IV. Provider business mailing address

12802 BOXWOOD LN
UNION BRIDGE MD
21791-7508
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-0929
  • Fax:
Mailing address:
  • Phone: 301-514-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR199454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: