Healthcare Provider Details

I. General information

NPI: 1932357985
Provider Name (Legal Business Name): BONNIE FRANCKOWIAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-4360
  • Fax: 410-243-7948
Mailing address:
  • Phone: 410-366-4360
  • Fax: 410-243-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR101981
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR101981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: