Healthcare Provider Details

I. General information

NPI: 1750383063
Provider Name (Legal Business Name): MALINDA DANIEL DUKE CPNP, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST RM N6W84
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

4950 CLEARWATER DR
ELLICOTT CITY MD
21043-6682
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3410
  • Fax: 410-328-0679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR079677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: