Healthcare Provider Details

I. General information

NPI: 1295109809
Provider Name (Legal Business Name): ABBY TAYLOR WEINRUB CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY TAYLOR PROUTT

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

3499 CLOVER MEADOW CT
FINKSBURG MD
21048-2346
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-0469
  • Fax:
Mailing address:
  • Phone: 443-307-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR187154
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP015592
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP015592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: