Healthcare Provider Details

I. General information

NPI: 1063651503
Provider Name (Legal Business Name): NICHOLAS DREW TROELEMAN RN,CNOR,RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5920
  • Fax:
Mailing address:
  • Phone: 410-328-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR163976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: