Healthcare Provider Details

I. General information

NPI: 1194281451
Provider Name (Legal Business Name): RICA BANFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 HUNTINGDON AVE
BALTIMORE MD
21211-2921
US

IV. Provider business mailing address

2832 HUNTINGDON AVE
BALTIMORE MD
21211-2921
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-9364
  • Fax:
Mailing address:
  • Phone: 240-423-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR207985
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR207985
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: