Healthcare Provider Details

I. General information

NPI: 1861046567
Provider Name (Legal Business Name): REBECCA WHITLOCK GROCHOWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA WHITLOCK

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL PL DEPT OF MED
BALTIMORE MD
21202-2165
US

IV. Provider business mailing address

301 SAINT PAUL PL DEPT OF
BALTIMORE MD
21202-2165
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9407
  • Fax: 410-332-9789
Mailing address:
  • Phone: 410-783-5858
  • Fax: 410-783-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR211857
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: